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Cases
Gynecology in the Upper Abdomen
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Background
A 33-year-old gravida 5 para 3 woman presents to the hospital because of abdominal pain in the left lower quadrant that has lasted 6 hours. The woman's last menstrual period was 6 weeks ago. Her past surgical history includes bilateral tubal ligation 4 years ago. The results of a urine pregnancy test are positive. The b–human chorionic gonadotropin level is 9132 mIU/mL. Transvaginal ultrasonography reveals an empty uterus. Ectopic pregnancy is diagnosed, and laparoscopy is performed, revealing an unruptured ectopic pregnancy (see Image 1). Laparoscopic left salpingectomy is performed. On exploration of the upper abdomen, Image 2 is obtained. What is the diagnosis?
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***** HINT *****
This condition has the same etiology as the tubal pregnancy.
***** ANSWER *****
Fitz-Hugh and Curtis syndrome: In 1920, Stajano first described perihepatitis followed by adhesions between the liver and parietal peritoneum. Fitz-Hugh and Curtis further described this association of perihepatitis with acute salpingitis in 1930. A past episode of acute salpingitis and perihepatitis are responsible for the classic violin-string adhesions depicted in Image 2. In the acute phase, the patient may have right upper quadrant pain. The appropriate antibiotics for managing acute salpingitis are aimed at treating the perihepatitis. After the acute phase, most patients have no right upper quadrant symptoms.
This case also demonstrates the fact that one third of pregnancies occurring after a tubal ligation are ectopic.
For more information about Fitz-Hugh and Curtis syndrome, please see the eMedicine article Fitz-Hugh-Curtis Syndrome.
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Author:
R. Daniel Braun, MD, FACOG
Professor of Clinical Obstetrics and Gynecology, Indiana University School of Medicine
eMedicine Editor:
William J. Brady, MD
Program Director of Emergency Medicine, Associate Professor, Departments of Internal Medicine and Emergency Medicine, University of Virginia School of Medicine
Source
http://emedicine.com
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