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[Venereal perihepatitis: Fitz-Hugh-Curtis syndrome]
V Durastante1, L Conte, A Cinque
1I Divisione di Chirurgia Generale con Servizio d'Urgenza, Ospedale Civile S. Maria della Misericordia, Udine.
Minerva Chirurgica
|September 1, 1995
Summary
Fitz-Hugh-Curtis syndrome, or venereal perihepatitis, is a complication of gonorrhea and chlamydia. Early diagnosis through genital tract investigation is crucial for effective treatment and management.
Area of Science:
- Gynecology
- Hepatology
- Infectious Diseases
Background:
- Fitz-Hugh-Curtis syndrome (FHCS), also known as venereal perihepatitis, is a complication of pelvic inflammatory disease.
- It is primarily associated with Neisseria gonorrhoeae and Chlamydia trachomatis infections.
Observation:
- FHCS typically presents with acute, biliary-type abdominal pain, often mimicking biliary colic or acute cholecystitis.
- Symptoms of associated genital infection are frequently absent, leading to diagnostic challenges.
- The actual clinical incidence of FHCS is considered high, with many emergency admissions for biliary issues potentially being undiagnosed cases.
Findings:
- Diagnostic workup involves excluding biliary lithiasis through hematological tests, ultrasonography, and cholangiography.
- If biliary causes are ruled out, investigation of the genital tract is essential.
- Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in cervical/vaginal secretions, along with serum antichlamydial antibodies, aids in diagnosis.
- Laparoscopy can confirm FHCS by visualizing characteristic "violin-string" adhesions between the liver capsule and abdominal wall.
Implications:
- Accurate diagnosis of FHCS is critical as it is often misdiagnosed as biliary disease.
- Prompt identification and treatment of the underlying gonococcal or chlamydial infection are necessary.
- Antibiotic therapies including tetracycline, doxycycline, and ofloxacin have demonstrated efficacy in treating FHCS.