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Fitz-Hugh-Curtis Syndrome

Pelvic infection causes syndrome

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Updated April 23, 2014

Fitz-Hugh-Curtis syndrome is a condition in which bacteria, usually from a pelvic infection, spread through the abdomen and cause inflammation of the tissue surrounding the liver. It occurs in 15-30% of women with pelvic inflammatory disease (PID), but may also occur in women without PID, and in men.

Symptoms
In Fitz-Hugh-Curtis syndrome, the inflammation of the liver tissue leads to the formation of abnormal tissue connections (adhesions) between the outside of the liver and the inside of the abdomen. In some individuals, these adhesions cause no symptoms. Others have severe pain in the upper right part of the abdomen, over the gallbladder. The pain may move to the right shoulder. Sometimes the pain increases with coughing, sneezing, or movement.

Since the source of Fitz-Hugh-Curtis syndrome is most often a pelvic infection, symptoms such as nausea, vomiting, chills, fever, and headaches may be present.

Diagnosis
In general, a physician cannot see or feel the presence of Fitz-Hugh-Curtis syndrome, so upper abdominal pain may suggest the diagnosis. The presence of a pelvic infection would also provide a clue to the diagnosis, but without PID the diagnosis may be difficult, since many conditions can cause abdominal pain. In women, cervical cultures for two particular pelvic infections, chlamydia and gonorrhea, will be done, since these infections are the most common causes of Fitz-Hugh-Curtis syndrome. If infection is present, the white blood cell count (WBC) in the blood will be high, as will the erythrocyte sedimentation rate (ESR).

The physician will examine the individual for common conditions which have symptoms similar to Fitz-Hugh-Curtis syndrome, such as gallstones, liver inflammation (hepatitis), kidney stones or infection, and stomach ulcer. Abdominal ultrasound and computed tomography (CT) scan can help rule out these disorders. A chest x-ray can rule out pneumonia as a cause of pain with coughing or sneezing.

Laparoscopy confirms diagnosis
The best way to confirm a diagnosis of Fitz-Hugh-Curtis syndrome is by the physician taking a look inside the body at the outside of the liver. This is done by inserting a camera inside the abdomen, called laparoscopy. The physician can see the adhesions on the outside of the liver, which have a typical stringy look (called "violin-string" adhesions).

Treatment
Treatment for the individual with Fitz-Hugh-Curtis syndrome consists of antibiotics for the infection and pain medicine. Once the infection is cleared up, the symptoms resolve. Since chlamydia and gonorrhea are spread through sexual contact, the individual must restrict her/his sexual activity until the infection is gone, and the individual's sexual partner(s) must also be treated.

Information for this article was taken from:
Frumovitz, M.M., & Ascher-Walsh, C.J. (2004). Fitz-Hugh-Curtis syndrome. eMedicine, accessed at http://www.emedicine.com/med/topic797.htm

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