Clinical Images  |   July 2020
Fitz-Hugh-Curtis Syndrome
Author Notes
  • From the Department of Obstetrics and Gynecology at St John's Episcopal Hospital in Far Rockaway, New York. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Daniel Martingano, DO, PhD, Department of Obstetrics and Gynecology, St John's Episcopal Hospital, 327 Beach 19th St, Far Rockaway, NY 11691. Email:
Article Information
Gastroenterology / Imaging / Clinical Images
Clinical Images   |   July 2020
Fitz-Hugh-Curtis Syndrome
The Journal of the American Osteopathic Association, July 2020, Vol. 120, 483. doi:
The Journal of the American Osteopathic Association, July 2020, Vol. 120, 483. doi:
A 37-year-old gravida 7 para 2-0-5-2 woman presented for scheduled bilateral salpingectomy with desired surgical sterilization. Her medical history included normal spontaneous vaginal delivery 6 weeks prior and Trichomonas vaginalis infection treated before pregnancy. The patient reported no past abdominal surgery or additional sexually transmitted infections. Laparoscopic intra-abdominal examination revealed numerous “violin-string” adhesions to the anterior surface of the liver, with an otherwise normal-appearing liver capsule and gall bladder (image A). Extensive adhesions also involved the omentum, small and large bowel, uterus, and bilateral adnexa (image B). 
Fitz-Hugh Curtis syndrome, or perihepatitis, occurs in approximately 10% of women with acute pelvic inflammatory disease and is often asymptomatic with chronic infections.1,2 Perihepatitis can manifest as a patchy, purulent, and fibrinous exudate (violin string adhesions) on laparoscopy. It most prominently affects the anterior surfaces of the liver, sparing the liver parenchyma, and is not associated with prominent liver dysfunction.3 The patient had successful bilateral salpingectomy with lysis of adhesions and an uncomplicated postoperative course. 
Wang SP, Eschenbach DA, Holmes KK, Wager G, Grayston JT. Chlamydia trachomatis infection in Fitz-Hugh-Curtis syndrome. Am J Obstet Gynecol. 1980;138(7 pt 2):1034-1038. doi: 10.1016/0002-9378(80)91103-5 [CrossRef] [PubMed]
Reichert JA, Valle RF. Fitz-Hugh-Curtis syndrome: a laparoscopic approach. JAMA. 1976;236(3):266-268. [CrossRef] [PubMed]
Sellors J, Mahony J, Goldsmith C, et al The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease. Am J Obstet Gynecol. 1991;164(1 pt 1):113-120. doi: 10.1016/0002-9378(91)90639-9 [CrossRef] [PubMed]