Fact-sheet: Perihepatatis Fitz-Hugh-Curtis syndrome


Updated on 08/17/2020 at 3:26 PM

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Definition

Inflammatory involvement of the hepatic capsule following a genital infection in women, through bacterial dissemination (most often Chlamydia trachomatis or Neisseria gonorrhoeae) into the retroperitoneum and the right paracolic gutter.

Clinical features

Severe right upper quadrant pain, signs suggestive of salpingitis: leukorrhea, fever +/- pelvic pain in a young woman with high-risk sexual intercourse.

Laboratory findings

Inflammatory syndrome
Chlamydia trachomatis serology or PCR

Ultrasound

Pelvic ultrasound:

  • Intraperitoneal effusion
  • Tubal wall thickening +/- pelvic abscess
  • Tubal collection

Abdominal ultrasound:

  • Gallbladder wall thickening.
  • Infiltrated appearance of the fatty tissue of the gallbladder fossa
  • Perihepatic collections.

CT

  • Enhancement of the hepatic capsule on the arterial phase with homogenization on the portal phase
  • Subcapsular hepatic perfusion abnormalities
  • rarely, visualization of perihepatic adhesions.
  • Preferential involvement of the right liver.

Management

Antibiotic treatment of the genital infection
Screening for STIs
On laparoscopy: visualization of "violin string" adhesions

Differential diagnosis

  • Cholecystitis
  • Pleural effusion
  • PE
  • Renal colic