A rare case of right upper abdominal pain

Abstract text (incl. references and figure legends)

A 29 years-old woman referred to our Emergency Department complaining right upper abdominal pain and nausea. She denied fever and urinary tract symptoms. Her previous medical history only included a sleeve gastrectomy. The physical examination revealed right upper quadrant tenderness and leucorrhoea.

Lab tests revealed leucocytosis (WBC 22479x10⁶/L ), increased C-reactive protein (4 mg/dL), mild hyperamylasaemia,transaminases and bilirubin in their normal range. Pregnancy was excluded. Based on these findings, cholecystitis was suspected. The abdominal US showed cholelithiasis and pericecal fluid but no signs of cholecystitis. The transvaginal US showed right luteal cyst and peri-salpinx free fluid.

In presence of an uncertain diagnosis, an abdominal contrast-enhanced CT scan was performed and showed an increased perihepatic enhancement in the arterial phase (Fig.1-2). Fitz-Hugh-Curtis Syndrome was diagnosed.

Endocervical culture positive for Chlamydia trachomatis confirmed the diagnosis. The patient was admitted to medical ward and intra-venous antibiotics were administered. The symptoms gradually improved and she was successfully discharged. Ten-day follow-up was negative.

Fitz-Hugh-Curtis Syndrome is a rare manifestation of Pelvic Inflammatory Disease, involving around 4% of adolescents.¹ It consists of perihepatitis, caused by inflammatory adhesion involving liver surface.² It commonly presents with right upper quadrant abdominal pain, worsened with movement and breathing, and associated with fever, nausea and vaginal discharge. It may mime other acute abdominal pathologies and its diagnosis is frequently done after diagnostic laparoscopy. It should be kept in mind as differential diagnosis of cholecystitis, appendicitis, renal colic, viral hepatitis and ectopic pregnancy.

1. Sonavane AD. Fitz-Hugh-Curtis syndrome.Indian J Med Res.2017 Jan;145(1):147

2. Shikino K. Fitz-Hugh-Curtis syndrome.BMJ Case Rep.2019 Feb13;12(2)

Fig.1 Axial CT

Fig.2 Coronal CT

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