About Fitz Hugh Curtis Syndrome

The Fitz-Hugh-Curtis syndrome, short FHC syndrome occurs predominantly as a complication after an inflammation of the pelvis on. Abdominal pain, nausea and vomiting occur.

What is Fitz-Hugh-Curtis Syndrome?

According to USVSUKENGLISH.COM, the disease was first noticed by a Uruguayan surgeon in 1920. It was first described by the American gynecologist Arthur Hale Curtis. In 1934 an American internist was able to confirm Curtis’ observations.

Fitz-Hugh-Curtis syndrome is therefore a complication of a previous inflammation of the pelvis. In most cases this is caused by chlamydia or other bacteria and leads to inflammation in the liver and diaphragm. The Fitz-Hugh-Curtis syndrome is therefore also known as perihepatitis.


Fitz-Hugh-Curtis syndrome is a complication of an ascending bacterial infection of the female genital area. The disease is often caused by chlamydia or gonococci. Chlamydia trachomata is a bacterium that causes a sexually transmitted disease in the urogenital tract. Timely treatment usually prevents consequential damage. But since two thirds of the women affected have no symptoms at all, the infection with chlamydia often goes unnoticed and only shows itself through later perihepatitis.

The gonorrhea caused by gonorrhea, often goes unrecognized. There may be itching and redness in the genital area. Also discharge is 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 the liver capsule. About a third of all patients with pelvic inflammation subsequently develop Fitz-Hugh-Curtis syndrome.

Symptoms, ailments & signs

The focus is on the symptoms of peritonitis, i.e. the inflammation of the peritoneum. The general condition of women is poor. The body temperature is greatly increased. The women affected complain of severe pain in the abdomen, especially pain in the upper right abdomen. The liver is tender on tender and possibly enlarged. The pain may extend into the right shoulder and intensify when the pressure in the abdomen increases (for example when sneezing, pressing or coughing).

The symptoms of the underlying disease are added to the symptoms of perihepatitis. With adnexitis, a combined inflammation of the fallopian tubes and ovaries, patients suffer from severe pain in the lower abdomen. If the cervix is also inflamed, discharge and spotting occurs.

If the Fitz-Hugh-Curtis syndrome is very pronounced, women vomit and a reflex bowel obstruction may occur. The intestine is not directly affected by the inflammation, but the nerves of the intestine react reflexively to the severe pain and stop functioning. As a result, the peristalsis of the intestine fails and an intestinal obstruction occurs. One speaks here of a paralytic ileus.


The symptoms of Fitz-Hugh-Curtis syndrome are rather uncharacteristic and therefore rarely provide a direct indication of the disease. In most cases, therefore, a laparoscopy is required to establish the diagnosis. In laparoscopy, the surgeon opens the abdominal wall with a small incision and inserts a special endoscope, which is provided with a light source and a video camera, into the abdominal cavity.

In this way he can assess the abdominal and pelvic organs. In Fitz-Hugh-Curtis syndrome, there are often adhesions between the liver and the diaphragm. If there are signs of infection of the genital tract, a vaginal and cervical swab will be performed. The pathogen is then detected microscopically or on the basis of a microbiological cultivation.

Particularly in the case of chlamydial and gonococcal infections, it should be noted that a negative pathogen culture does not rule out an infection. That is why the detection of chlamydia and gonococci is now usually carried out using molecular genetic methods.

The pathogen can be detected by means of direct molecular genetic or indirect molecular genetic diagnostics. In most cases, however, a direct gene detection is carried out by a sequence analysis from the DNA. In order to rule out liver diseases such as fatty liver hepatitis, viral hepatitis or liver cirrhosis as the cause of the inflammation, an ultrasound examination of the abdomen must also be carried out.


Perihepatitis, also known as Fitz-Hugh-Curtis syndrome, is a complication in itself. It occurs when there is bacterial inflammation in the genital tract of women. The inflammation spreads or rises. If this diagnosis is presented, tissue adhesions caused by inflammation can occur between the inner abdominal wall and the liver capsule.

A diaphragm used for contraception can also be affected by such adhesions. The contraceptive may not be safe enough because it is not properly seated in the uterus. If necessary, changing the contraceptive is indicated. In any case, a woman is not allowed to use a diaphragm in the case of an acute and spreading urogenital infection.

In Fitz-Hugh-Curtis syndrome, severe tissue sticking to the liver capsule can occur. In this case, a laparoscopic relief operation may be performed to surgically separate the fused tissue. The infection with chlamydia or other pathogens underlying Fitz-Hugh-Curtis syndrome must be treated separately.

In rare cases, Fitz-Hugh-Curtis syndrome leads to post-infectious arthritis, the so-called Reiter syndrome. This can lead to autoimmunological cross-reactions in rare cases. However, since Fitz-Hugh-Curtis syndrome itself rarely occurs in us, such complications are rather the exception. Why reactive arthritis heals in some people but can persist for years in others has not been adequately researched.

When should you go to the doctor?

A doctor should always be seen in Fitz-Hugh-Curtis syndrome. If treatment is not given, the inflammation can spread to other parts of the body, causing serious discomfort and complications. A doctor should then be consulted if the person concerned suffers from severe pain in overuse and also from a fever. The temperature of the body is significantly increased. The patient’s liver can also be painful and is often enlarged so that it is also pressing against other organs.

Furthermore, high pressure in the abdomen when coughing or sneezing can indicate Fitz-Hugh-Curtis syndrome. The cervix can also become inflamed and the person may have discharge or spotting. If Fitz-Hugh-Curtis syndrome is not treated, bowel obstruction can still occur.

In this case, immediate treatment by an emergency doctor or in a hospital is necessary. The diagnosis and treatment of the syndrome is, in most cases, carried out in a hospital by a surgeon. For treatment, those affected are dependent on taking antibiotics. This usually completely limits and alleviates the symptoms.

Treatment & Therapy

Therapy is initially carried out by administering antibiotics. The antibiotic is selected specifically for the pathogen. Nonsteroidal anti – inflammatory drugs such as ibuprofen, diclofenac, or piroxicam can be given to relieve the pain.

If the laparoscopy shows severe adhesions between the liver capsule and the diaphragm and other surrounding structures, this is an indication for laparoscopic adhesiolysis. The adhesions and adhesions are severed during the laparoscopy.

Outlook & forecast

Fitz-Hugh-Curtis syndrome is a disease that usually only affects women. It is a complication of infectious pelvic inflammation (PID) caused by sexually transmitted germs such as chlamydia. This leads to inflammatory processes in the uterus, ovaries, fallopian tubes and vagina.

Fitz-Hugh-Curtis syndrome, which is 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 in particular are at risk of contracting these pathogens through sexual contact. In very rare cases, men can also develop Fitz-Hugh-Curtis syndrome.

Immediate antibiotic treatment is imperative to avoid serious complications. The choice of antibiotics depends on the particular pathogen. Local purulent-fibrinous inflammations in the peritoneum, which can lead to adhesions, sometimes develop as complications.

These adhesions tend to occur between the liver and the abdominal wall or between the liver and diaphragm. The resulting scarring often causes chronic abdominal pain. In the case of particularly persistent complaints, the scar tissue should be removed by surgery, using the method of laparoscopic surgery.

Another complication of Fitz-Hugh-Curtis syndrome is the acute deterioration in health through the development of potentially life-threatening sepsis.


Fitz-Hugh-Curtis syndrome can only be prevented through early treatment of the underlying disease. Regular visits to the gynecologist quickly reveal any bacterial infections of the genital tract. During the annual check-up, the gynecologist checks the cervix and the cervix and takes a smear to detect infections with chlamydia.

If there are symptoms such as pelvic pain, discharge or spotting outside of these preventive medical check-ups, a doctor should be consulted as soon as possible. Only early treatment by a doctor can prevent consequential damage. Chlamydia and gonococcal infections can be prevented through protected sexual intercourse.

In order to prevent inflammation of the pelvis and thus also the Fitz-Hugh-Curtis syndrome, it is important to use condoms for both anal sex and vaginal sex. A condom should also be used if the penis briefly penetrates the vagina during foreplay. Women should also always protect themselves with a condom if sex toys such as dildos or vibrators are shared with other people.


Follow-up care options are severely limited in Fitz-Hugh-Curtis syndrome. The patient is primarily dependent on the medical treatment of this disease in order to prevent further complications and also the further spread of the inflammation. Therefore, early diagnosis is of great importance for this disease in order to completely alleviate the symptoms.

Fitz-Hugh-Curtis syndrome is treated conservatively with the help of medication. The patients are dependent on the intake of antibiotics, whereby it is important to ensure that they are taken regularly. With the help of pain relievers, the inflammation can be further relieved. During treatment, the patient should avoid alcohol and other drugs as much as possible in order not to reduce the effect of the medication.

In most cases, further compilations do not occur. Even after the symptoms have subsided, the medication should be taken for a few days to completely relieve the symptoms of Fitz-Hugh-Curtis syndrome. In case of doubt, a doctor should always be consulted. A new examination of the body by a doctor is also necessary after the treatment. Life expectancy for this disease usually remains unchanged if the disease is treated in good time.

You can do that yourself

Patients with Fitz-Hugh-Curtis syndrome should drink enough fluids due to the high body temperature. Despite a loss of appetite, the organism needs fluids so that it does not become dehydrated. Mineral water or lots of fruit help to keep the household in balance.

To avoid further complications, you should refrain from consuming fatty or unhealthy foods. The diet should be balanced and rich in vitamins so that the digestive process is burdened as little as possible. The meals should not be too large, as this can lead to more severe symptoms.

Several smaller meals help as well as a sufficient break until the next food intake. In addition, a healthy lifestyle supports the immune system. This means that the body has sufficient defenses at its disposal in the fight against inflammation. A stay in the fresh air, walks or light sporting activities can further strengthen the organism.

The patient should motivate himself and participate in social life despite existing complaints. The exchange with other people can lead to help and support that is important for the patient. Conversations with relatives or those who are also ill help to reduce existing fears or concerns. By dealing openly with Fitz-Hugh-Curtis syndrome, people in their immediate environment can better respond to the needs of those affected.

Fitz Hugh Curtis Syndrome