Fitz-Hugh-Curtis (FHC) disorder could be a perihepatitis connected to provocative pelvic infection. It can be caused by Neisseria gonorrhoeae or Chlamydia trachomatis infections. FHC disorder ordinarily presents with torment within the right hypochondrium and fever, related to indications and signs of pelvic contamination in ladies.

Clinical Presentation

Clinically, the conclusion of FHCS can be troublesome since it may mirror numerous other illnesses, counting acute cholecystitis, pneumonia, pulmonary embolism, renal colic and punctured peptic ulcer.¹ The diagnosis is indeed more troublesome when pelvic indications are truant, or when perihepatitis presents long some time recently or after the indications of the pelvic inflammatory disease (PID).²

Patients displayed with the following:

• Non-specifically diagnosed acute abdominal pain.
• Right upper quadrant abdominal pain exacerbated by development and breathing.
• Symptoms of intense or sub-acute PID (fever, abdominal pain, vaginal discharge).
• Systemic lupus erythematosus (SLE) with polyarthritis, cutaneous injuries, and abdominal pain.³

Pathogenesis

The pathogenesis of FHCS remains questionable; however, several possible mechanisms have been proposed, counting direct, hematogenous, and lymphatic spread. Exudative liquid can deplete along the paracolic canals from the pelvis to the stomach, causing perihepatitis taken after by adhesions. However, since many patients show no evidence of generalized intra-abdominal disease between the pelvis and the liver, hematogenous or lymphatic spread are proposed. Uncommon cases of FHCS happening in men also support these speculations.¹⁰

Diagnostic Criteria

Diagnosing Fitz-Hugh-Curtis Syndrome includes a combination of clinical assessment, laboratory testing, imaging studies, and sometimes surgical investigation. Here are the essential symptomatic criteria and steps:

Clinical Assessment

On physical examination, patients have direct to extreme tenderness within the right upper quadrant, with a few guarding and conceivably splinting. A bimanual pelvic examination may identify vaginal discharge, cervical motion tenderness, or adnexal tenderness already unnoticed by the patient.⁴

Laboratory Studies

Blood cultures for finding bacterial infection.

Genetic amplification tests such as the ligase chain reaction (LCR) and nucleic acid amplification test.⁵

Complete blood count, c-reactive proteins, and liver function tests. 

Imaging Studies

Ultrasound of the abdomen

Ultrasound signs are seldom detailed and are constrained to perihepatic fluid effusion. Ultrasound can moreover search for intra-abdominal lymphadenopathy or other intra-abdominal tuberculosis localizations which will be related.⁶

CT scan of the abdomen

Using a biphasic CT examination, including an AP scan obtained at the ideal transient window, the delineation of the expanded perihepatic enhancement can be significantly improved. Utilizing this method, the affectability and the precision of diagnosing FHCS can be particularly expanded amid the assessment of patients with acute RUQ pain or in the event that there is the doubt of FHCS.⁷

MRI of the abdomen

MRI is well suited for the assessment of PID and its complications due to its prevalent soft tissue contrast and high sensitivity for irritation. MRI findings in acute PID incorporate cervicitis, endometritis, salpingitis/oophoritis, and inflammation in the pelvic soft tissues.⁸

Laparoscopy

Laparoscopy shows multiple violin-string attachments of the parietal peritoneum to the liver and miliary-like nodules on the peritoneal surfaces. Diagnostic laparoscopy can be valuable for diagnosis of intra-abdominal lesions and adhesions. Localized lesions and adhesions can too be treated utilizing endoscopic resection with antibiotic adjuvants for side effect control and treatment.⁹

Differential Diagnosis

As it is troublesome to suspect FHCS upon first impression, the initial diagnoses of FHCS patients regularly incorporate:

• Gallbladder stones: Gallstones are little stones, ordinarily made of cholesterol, that shape within the gallbladder.
• Acute cholecystitis: Irritation of the gallbladder, that happens due to impediment of the cystic channel or impeded purging of the gallbladder.
• Duodenal ulcer:  A sore that forms within the lining of the duodenum, the primary portion of the small intestine.
• Liver abscess: A mass filled with pus inside the liver.
• Subphrenic abscess: Disease characterized by an aggregation of infected liquid between the stomach, liver and spleen.
• Herpes zoster disease: Viral disease that causes an episode of a painful rash or rankles on the skin.
• Acute pyelonephritis: Bacterial disease that causes inflammation of the kidneys and renal pelvis.

Summary

Fitz-Hugh-Curtis Syndrome is an imperative thought in ladies presenting with RUQ pain, especially in the event that there is a history or doubt of PID. Opportune conclusion and suitable administration are vital to anticipate complications and guarantee a full recovery.