Fitz-Hugh-Curtis Syndrome

Fitz-Hugh-Curtis syndrome (FHCS), or perihepatitis, is a chronic manifestation of pelvic inflammatory disease (PID). It is described as an inflammation of the liver capsule, without the involvement of the liver parenchyma, with adhesion formation accompanied by right upper quadrant pain. A final diagnosis can be made through laparoscopy or laparotomy via direct visualization of violin string-like adhesions or through hepatic capsular biopsy and culture. The syndrome was first illustrated by Stajano in 1920 in a non-English publication. In 1930 Curtis described adhesions between the anterior surface of the liver and the abdominal wall found during laparotomies in patients with atypical gallbladder attacks. He noted that while no other upper abdominal pathology was found, residual gonococcal tubal changes were frequently observed in the subjects. In 1934, Fitz-Hugh, Jr. described similar cases which had presented with right upper quadrant abdominal pain. Laparotomy showed unusual, localized, peritonitis involving the anterior surface and edge of the liver and adjacent peritoneal surface of the diaphragm. After drainage, tube insertion smears from drained fluid showed gram-negative, intracellular, biscuit-shaped diplococci. It is now known, however, that the syndrome is not exclusive to gonococcal infection and has been reported in both sexes.