Fitz Hugh Curtis Syndrome occurs in ~10% of women with acute PID and can be associated with both gonococcal salpingitis and Chlamydia trachomatis.  Symptomatic patients will experience right upper quadrant abdominal pain, which can be referred to the right shoulder.  This pain is similar in nature to of cholecystitis, often leading to a more challenging diagnosis. 

Majority of individuals affected with Fitz Hugh Curtis Syndrome are of child-bearing age.  Treatment is patient specific and geared to treating the patient’s symptoms.  Initial treatment includes antibiotics (especially if the infection is still present) and pain medications.  If the pain is unresolved a patient may undergo a laparotomy to remove the adhesions in the perihepatic region. 

There were not very many articles to choose from when researching Fitz Hugh Curtis Syndrome in an elderly population.  However, the article selected discusses a new approach to visualizing the adhesions in the perihepatic region also called ‘violin string sign.’  Given the comorbidities that come with age, the purpose of the research was to determine whether the microvascular structure of the inflamed portion between the abdominal wall and the surface of the liver could be visualized.

The article, indexed for medline, presents a case report where an elderly patient presented with right upper quadrant abdominal pain who underwent superb microvascular imaging (SMI) system to avoid the slightly invasive laparoscopic diagnostic procedure.  This technique is new and was developed to observe low vascular flow that cannot otherwise be observed by conventional color Doppler imaging.  The researchers were able to successfully observe the microvascular structures of the inflamed portion between the abdominal wall and the surface of the liver in this elderly patient.  Given the patient had positive Anti-chlamydial antibodies, the SMI signals suggest small vessels passing from the liver surface to the hypoechoic space consistent with perihepatic lesions as seen in FHCS.  Elderly patients with FHCS are rare and this imaging tool is useful for observing these microvascular structures related to inflammation to help dictate treatment and avoid any sort exploratory surgery.

Of note, there were other articles available, however, they were not indexed for medline and the patient population was not appropriate for the purposes of this assignment.  The patient seen during the rotation was a 78 year old woman with severe RUQ pain.  During the cholecystectomy, the perihepatic adhesions were lysed hopefully alleviating any pain caused by her inflamed gallbladder but also Fitz Hugh Curtis Syndrome. 

Download the article: Elderly_Fitz-Hugh-Curtis_syndrome_observed_with_su

Sources:
https://rarediseases.org/rare-diseases/fitz-hugh-curtis-syndrome/
https://www.uptodate.com/contents/pelvic-inflammatory-disease-clinical-manifestations-and-diagnosis?search=fitz%20hugh%E2%80%93curtis%20syndrome&source=search_result&selectedTitle=1~40&usage_type=default&display_rank=1#H155838

This entry is licensed under a Creative Commons CC0 1.0 Universal Public Domain Dedication license.