Fitz-Hugh-Curtis syndrome, or FHC syndrome, occurs predominantly as a complication following inflammation in the pelvic region. Abdominal pain, nausea, and vomiting occur.
What is Fitz-Hugh-Curtis syndrome?
The condition was first noticed by a Uruguayan surgeon in 1920. It was first described by American gynecologist Arthur Hale Curtis. In 1934, an American internist was able to confirm Curtis’ observations. According to this, the Fitz-Hugh-Curtis syndrome is a complication of a preceding inflammation of the small pelvis. In most cases, this is caused by chlamydia or other bacteria and leads to inflammation of the liver and diaphragm. Fitz-Hugh-Curtis syndrome is also called perihepatitis for this reason.
Causes
Fitz-Hugh-Curtis syndrome is a secondary complication of an ascending bacterial infection of the female genital area. The condition is often caused by chlamydia or gonococcus. Chlamydia trachomata is a bacterium that causes a sexually transmitted disease in the genitourinary tract. Timely treatment usually prevents secondary damage. However, since two-thirds of affected women have no symptoms at all, infection with chlamydia often goes unnoticed and only becomes apparent through subsequent perihepatitis. Gonorrhea, caused by gonococci, also often remains undetected. There may be itching and redness in the genital area. Discharge is also a possible symptom of gonorrhea. If timely treatment is missed, the fallopian tubes and ovaries can become inflamed. As a result, the bacteria can rise and cause inflammation of the peritoneum and liver capsule. About one-third of patients with pelvic inflammatory disease subsequently develop Fitz-Hugh-Curtis syndrome.
Symptoms, complaints, and signs
The main symptoms are those of peritonitis, or inflammation of the peritoneum. The general condition of the women is poor. The body temperature is greatly elevated. Affected women complain of severe abdominal pain, especially pain in the right upper abdomen. The liver is tender to pressure and possibly enlarged. Possibly, the pain extends to the right shoulder and intensifies when the pressure in the abdomen increases (for example, when sneezing, pressing or coughing). The symptoms of perihepatitis are joined by those of the underlying disease. In adnexitis, a combined inflammation of the fallopian tubes and ovary, patients suffer from severe pain in the lower abdomen. If the cervix is also inflamed, there is discharge and spotting. If Fitz-Hugh-Curtis syndrome is severe, women vomit and there may be reflex bowel obstruction. Although the bowel is not directly affected by the inflammation, the nerves of the bowel react reflexively to the severe pain and stop functioning. As a result, the peristalsis of the intestine fails and intestinal obstruction occurs. This is also referred to as paralytic ileus.
Diagnosis
The symptoms of Fitz-Hugh-Curtis syndrome are rather uncharacteristic and therefore rarely provide direct evidence of the disease. Thus, laparoscopy is required to establish the diagnosis in most cases. During laparoscopy, the surgeon opens the abdominal wall with a small incision and inserts a special endoscope, which is equipped with a light source and a video camera, into the abdominal cavity. This allows him to evaluate the abdominal and pelvic organs. Fitz-Hugh-Curtis syndrome often shows adhesions, called adhesions, between the liver and the diaphragm. If there are signs of infection of the genital tract, a vaginal and cervical smear is performed. The pathogen is then detected by microscopy or microbiological cultivation. Particularly in the case of chlamydial and gonococcal infections, it should be noted that a negative pathogen culture does not exclude an infection. For this reason, the detection of chlamydia and gonococci is nowadays usually carried out using molecular genetic methods. The pathogen can be detected by direct molecular genetic or indirect molecular genetic diagnostics. In most cases, however, direct genetic detection is performed by sequence analysis from the DNA.In addition, to rule out liver diseases such as fatty liver hepatitis, viral hepatitis, or cirrhosis as a cause of the inflammation, an ultrasound examination of the abdomen must be performed.
Complications
Perihepatitis, also known as Fitz-Hugh-Curtis syndrome, is itself a complication. It develops when bacterial inflammation occurs in the genital tract of women. The inflammation spreads or rises, respectively. When this diagnosis is presented, tissue adhesions between the internal abdominal wall and the liver capsule due to inflammation may occur. A diaphragm used for contraception may also be affected by such adhesions. It is possible that the contraceptive device is no longer secure enough because of an inadequately secure fit in the uterus. If necessary, a change of contraceptive is indicated. In any case, a woman should not use a diaphragm if she has an acute and spreading urogenital infection. There may be serious tissue adhesions to the liver capsule in Fitz-Hugh-Curtis syndrome. In this case, laparoscopic decompression surgery may be performed to surgically separate the tangled tissue. The underlying infection of Fitz-Hugh-Curtis syndrome with chlamydia or other pathogens must be treated separately. In rare cases, Fitz-Hugh-Curtis syndrome results in post-infectious arthritis, known as Reiter’s syndrome. This can lead to autoimmunological cross-reactions in rare cases. However, since Fitz-Hugh-Curtis syndrome itself rarely occurs in our country, such complications tend to be the exception. Why reactive arthritis resolves in some affected individuals but may persist for years in others has not been adequately explored.
When should you see a doctor?
A doctor should always be consulted for Fitz-Hugh-Curtis syndrome. If treatment is not received, the inflammation can spread to other regions of the body, leading to serious symptoms and complications. A doctor should be consulted if the affected person suffers from severe pain in the upper abdomen and also fever. The temperature of the body is significantly elevated. The patient’s liver may also hurt and is often enlarged, so that it also presses against other organs. Furthermore, high pressure in the abdomen when coughing or sneezing may indicate Fitz-Hugh-Curtis syndrome. Likewise, the cervix may suffer from inflammation and the affected person may have a discharge or spotting. If Fitz-Hugh-Curtis syndrome is not treated, bowel obstruction may continue to occur. In this case, immediate treatment by an emergency physician or in a hospital is necessary. In most cases, the syndrome is diagnosed and treated in a hospital by a surgeon. During treatment, those affected depend on taking antibiotics. This usually allows the symptoms to be completely limited and alleviated.
Treatment and therapy
Therapy is initially carried out by administering antibiotics. The antibiotic is selected specifically for the pathogen. To relieve pain, nonsteroidal anti-inflammatory drugs such as ibuprofen, diclofenac, or piroxicam may be administered. If laparascopy shows severe adhesions of the liver capsule to the diaphragm and other surrounding structures, this is an indication for laparascopic adhesiolysis. This involves cutting the adhesions and adhesions during laparoscopy.
Outlook and prognosis
Fitz-Hugh-Curtis syndrome is a condition that usually affects only the female sex. It is a complication of infectious pelvic inflammatory disease (PID) caused by sexually transmitted germs such as chlamydia. It involves inflammatory processes in the uterus, ovaries, fallopian tubes and vagina. Fitz-Hugh-Curtis syndrome, characterized by swelling of the peritoneum around the liver, is seen in approximately 15 to 30 percent of women with PID. Women of childbearing age and young girls are particularly at risk for contracting these pathogens during sexual contact. In very rare cases, men may also contract Fitz-Hugh-Curtis syndrome. Immediate antibiotic treatment is essential to avoid serious complications. The choice of antibiotics depends on the particular pathogen.As complications, local purulent-fibrinous inflammations sometimes form in the peritoneum, which can lead to adhesions. These adhesions occur preferentially between the liver and the abdominal wall or between the liver and the diaphragm. The resulting scarring often causes chronic abdominal pain. If the symptoms are particularly persistent, the scar tissue should be removed by surgery, resorting to the method of laparoscopic surgery. Acute deterioration of health due to the development of potentially life-threatening sepsis is also a further complication of Fitz-Hugh-Curtis syndrome.
Prevention
Fitz-Hugh-Curtis syndrome can be prevented only by early therapy of the underlying disease. Regular visits to the gynecologist quickly bring to light any bacterial infections of the genital tract. At the annual check-up, the gynecologist checks the cervix and cervical os and takes a smear test to detect infections with chlamydia. If symptoms such as lower abdominal pain, discharge or spotting occur outside of these check-ups, a doctor should be consulted as soon as possible. Only early treatment by a doctor can prevent subsequent damage. Infections with chlamydia and gonococci can be prevented by protected sexual intercourse. To prevent pelvic inflammatory disease and thus Fitz-Hugh-Curtis syndrome, it is important to use condoms during both anal sex and vaginal sex. It is also imperative to use a condom during brief penetration of the penis into the vagina during foreplay. Women should also always protect themselves with a condom when sharing sex toys, such as dildos or vibrators.
Aftercare
The options for follow-up care are severely limited in Fitz-Hugh-Curtis syndrome. The patient is primarily dependent on medical treatment of this disease to prevent further complications and also further spread of inflammation. Therefore, early diagnosis is of great importance in this disease, above all, in order to completely alleviate the symptoms. Fitz-Hugh-Curtis syndrome is treated conservatively with the help of medication. Patients are dependent on taking antibiotics, and care must be taken to ensure that they are taken regularly. Painkillers can be used to further relieve the inflammation. During treatment, the patient should avoid alcohol and other drugs as much as possible, so as not to reduce the effect of the medication. Further compilations do not occur in most cases. Even after the symptoms have subsided, the medication should continue to be taken for a few days in order to completely alleviate the symptoms of Fitz-Hugh-Curtis syndrome. In case of doubt, a doctor should always be consulted. Likewise, after the treatment, a new examination of the body by a doctor is necessary. Life expectancy usually remains unchanged in this condition if the disease is treated in time.
What you can do yourself
Patients of Fitz-Hugh-Curtis syndrome should drink enough fluids because of the high body temperature. Despite a loss of appetite, the organism needs fluids so that it does not become dehydrated. Mineral water or plenty of fruit will help to keep the household in balance. To avoid further complications, the consumption of fatty or unhealthy foods should be avoided. The diet should be balanced and rich in vitamins to minimize the digestive process. Meals should not be too sumptuous, as this can lead to more severe discomfort. Several smaller meals help, as does a sufficient break until the next food intake. In addition, a healthy lifestyle supports the immune system. The body thus has sufficient defenses at its disposal in the fight against inflammation. Stays in fresh air, walks or light sporting activities can further strengthen the organism. The patient should motivate himself and cultivate participation in social life despite existing complaints. The exchange with other people can lead to assistance and support, which are important for the patient. Discussions with relatives or people who are also ill help to reduce existing fears or concerns.By being open about Fitz-Hugh-Curtis syndrome, people in the immediate community can be more responsive to the needs of the person with the condition.
