Incidental liver abnormalities at laparoscopy for benign gynecologic conditions

Incidential Fitz-Hugh-Curtis syndrome at laparoscopy for benign gynecologic conditions

OBJECTIVES

To assess the prevalence of incidental Fitz-Hugh-Curtis syndrome in women undergoing diagnostic laparoscopy for sterilization, infertility or chronic pelvic pain.

METHODS

This was a prospective study over a 4-year period in which a total of 320 women undergoing diagnostic laparoscopy for sterilization [Group I, 200 women (62.5%)], infertility [Group II, 60 women (18.7%)], or chronic pelvic pain [Group III, 60 women (18.7%)] were enrolled. After examination of the pelvic area and abdominal cavity, the liver area was visualized in all cases for evidence of perihepatitis and adhesions between liver and anterior abdominal wall or diaphragm (Fitz-Hugh-Curtis syndrome). Statistical analysis was performed using the chi-square test, with a P-value set at 0.05 for significance.

RESULTS

The mean age was similar in the three groups, while mean parity was obviously less in the infertility group. Fitz-Hugh-Curtis syndrome was observed in 16 women (8%) in Group I, 10 women (16.6%) in Group II, and 18 women (30%) in Group III. The prevalence was highest in Group III and the difference was statistically highly significant in Group III vs. Group I (P<0.001), and in Group III vs. Group II (P<0.01). It was higher in the infertility group than in the sterilization group (P<0.05 in Group II vs. Group I).

CONCLUSIONS

There was a very high prevalence of incidental Fitz-Hugh-Curtis syndrome in the chronic pelvic pain and infertility groups, and even in the sterilization group.

Mechanical partial small bowel obstruction in a patient with Fitz-Hugh-Curtis syndrome

Perihepatitis or Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease that usually leaves characteristic violin string adhesions on the anterior liver surface. These adhesions are common incidental findings on subsequent laparoscopy or laparotomy and are considered benign. We present a case of partial mechanical small bowel obstruction as a sequel of this syndrome that was diagnosed and treated laparoscopically.