Fitz-Hugh-Curtis Syndrome in a Male Patient

Abstract

We report the case of a 38-year-old Middle Eastern man with intractable right upper quadrant (RUQ) abdominal pain and several emergency department visits during the last seven years, with extensive and repeated radiologic and endoscopic workups proven negative for biliary or upper gastrointestinal disease. He presented to our outpatient surgical clinic in March 2023 complaining of worsening RUQ and epigastric pain and was scheduled for a robotic cholecystectomy for presumed biliary dyskinesia following a repeat cholescintigraphy (hepatobiliary iminodiacetic acid) scan. During a cholecystectomy, extensive bilobar perihepatic adhesions were found, indicative of Fitz-Hugh-Curtis syndrome (FHCS). A thorough lysis of adhesions was performed along with a wedge liver biopsy, with subsequent histological examination showing chronic cholecystitis, perihepatic mesothelial fibrosis with mild subcapsular hepatic steatosis, and no evidence of liver fibrosis. The patient was examined in the clinic two weeks after surgery with complete resolution of symptoms. This case highlights the importance of considering FHCS in the differential diagnosis of male patients presenting with refractory RUQ abdominal pain despite a negative workup. Early recognition and prompt treatment can prevent unnecessary extensive, repeat testing and delays in intervention in these patients.

Keywords: case report; fitz-hugh-curtis syndrome; general surgery; perihepatitis; sexually transmitted disease (std).

Figure 1. CT scan of abdomen and pelvis with a repeat in three years.

The left upper and bottom panels represent the prior CT scans showing a distended non-inflamed gallbladder (yellow arrows). The right upper and bottom panels represent the latter CT scan showing a constricted non-inflammed gallbladder (green arrows). Both show no gallstones, wall thickening, or pericholecystic fluid suggesting acute cholecystitis.

Figure 2. Intraoperative laparoscopic images of perihepatitis and contracted and intrahepatic gallbladder.

Image 1: Perihepatic adhesions seen plastering the liver to the abdominal wall due to adhesions (arrow). Image 2: Retraction of the liver and intrahepatic gallbladder (asterisk) on the abdominal wall superiorly due to adhesions (arrowhead) despite patient positioning in reverse Trendelenburg. Image 3: Adhesive bands are seen on the inferior portion of the liver to the small bowel (arrow). Image 4: A thin veil-like adhesion seen on the superior liver border and abdominal wall (arrow).

Figure 3. Intraoperative robotic images of perihepatitis.

Perihepatic adhesions are taken down using robotic instruments seen under tension as violin string-like adhesions.