A case of Fitz Hugh Curtis syndrome mimicking an acute abdomen

Abstract

Fitz Hugh Curtis syndrome, also known as acute perihepatitis, associates pelvic inflammatory disease with the presence of Chlamydia trachomatis or Neisseria gonorrhoeae as the main causative pathogens. Symptomatology is a nonspecific one. Right upper quadrant pain, fever, nausea and vomiting are the most commonly encountered symptoms. Imaging data are also nonspecific and often show intra-abdominal changes with no particularity. As it is difficult to suspect Fitz Hugh Curtis syndrome upon first impression, laparoscopy and direct visualization of the peritoneum and liver adhesions are needed in the diagnostic process. The specific aspect of the fibrinous strands can raise the suspicion of this disease and guide the subsequent treatment. We present the case of a 19-year-old patient with abdominal pain observed in the right upper quadrant and moderate anemia for which she was investigated in the hematology ward. The unfavorable evolution with the appearance of anemia and peritonitic acute abdomen signs required a surgical approach. The intraoperative aspects raised the suspicion of Fitz Hugh Curtis syndrome. Because of the nonspecific clinical picture as well as the insignificant imaging features, this condition can be a diagnostic and therapeutic challenge.