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With the expanding indications for minimally invasive surgery, the management of small bowel obstruction is evolving. The laparoscope shortens hospital stay, hastens recovery, and reduces morbidity, such as wound infection and incisional hernia associated with open surgery. However, many surgeons are reluctant to attempt laparoscopy in patients wit...
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... patient was treated conservatively overnight with bowel rest and nasogastric tube decompression. Her symptoms did not improve with conservative treatment, and she was taken to the operating room for a diagnostic laparoscopy. The peritoneal cavity was easily accessed using an infraumbilical Hassan technique and pneumo-peritoneum was established to 15 mm Hg. After the cam- era was inserted, a loop of jejunum was found incarcer- ated by adhesive bands in the right upper quadrant (Figure 2). The intraoperative diagnosis was an adhesive SBO secondary to Fitz-Hugh-Curtis syndrome. The adhe- sions were easily taken down with endoscopic scissors, and the small bowel obstruction was released ( Figure 3). The incarcerated portion of bowel was viable, and the remaining small bowel was examined. No other area of obstruction was found. Postoperatively, the patient did well and was discharged home on hospital day ...
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Citations
... Until now, small bowel obstructions associated with FHCs that require surgical intervention have rarely been described. As in previous reports, our patient had no history of PID or gynecological symptoms (5,9,10). However, considering that laparoscopic observation of the typical signs of violinstring adhesions plays an important role in diagnosis (8), it was thought that our patient also developed Chilaiditi syndrome caused by FHCs. ...
... Si no se realiza la lisis, se aconseja dejar constancia de su presencia y advertir a la paciente, para no incurrir en el futuro en errores diagnósticos adjudicando el cuadro clínico a patología de la vía biliar. Aunque más infrecuente, también existen publicaciones de casos de obstrucción intestinal debida a estas adherencias (28,29) . ...
The Fitz-Hugh-Curtis syndrome is a rare clinical presentation of upper genital infections, characterized by pain in the right hypochondrium, few pelvic symptoms, and “violin strings” hepatophrenic adhesions. This unusual clinical presentation leads to frequent late or erroneous diagnoses, such as cholecystitis, appendicitis, urolithiasis or hepatophrenic abscesses. Based on the clinical case presented, a historical and chronological review of knowledge and publications over time, on this particular clinical presentation was conducted.
... 30,31 Although more infrequent, there are also publications of cases of intestinal obstruction due to these adhesions. 32,33 If during a laparoscopy adhesiolysis is performed, great attention must be paid to hemostasis, since when abdominal pressure drops and when the pneumoperitoneum is released, they may begin to bleed. 34 The blood test are the usual on PID, that is, leukocytosis with neutrophilia in half of the patients, and frequent elevation of C-reactive protein and erythrocyte sedimentation rate. ...
Stajano, Fitz-Hugh, Curtis Syndrome is a rare clinical presentation of upper genital infections, characterized by few pelvic symptoms and perihepatitis attributed to direct bacterial infection. The perihepatic component usually presents as right hypochondrium pain, tenderness, and "violin strings" hepatophrenic adhesions. This atypical clinical presentation leads to frequent late or misdiagnoses, such as cholecystitis, appendicitis, pancreatitis, pyelonephritis, urolithiasis, or hepatophrenic abscesses. In this paper we carried out a historical review of the knowledge that have occurred over time, of this particular clinical presentation.
... [7] Similar to patients in earlier reported cases, our patient had no history of documented PID or gynecological complaints. [8,9] However, the authors believe that her adhesive SBO was due to PID based on the following reasons. First, she was a sexually active young woman. ...
... [10] About two-thirds of patients with Fitz-Hugh-Curtis syndrome develop clinical manifestations such as acute/chronic right abdominal pain mimicking acute cholecystitis/biliary colic. [9,10] Rarely, patients present with intestinal obstruction due to entrapment of the intestine between the "violin string" adhesions (Chilaiditi syndrome). [8] Our patient was among one-third of patients who have asymptomatic Fitz-Hugh-Curtis syndrome. ...
We report a rare case of a 32-year-old woman with adhesive small bowel obstruction due to pelvic inflammatory disease. She had no history of abdominal surgery, gynecological complaints or constitutional symptoms of chronic illness. The diagnosis was based on the laparoscopic findings of small bowel adhesions, free peritoneal fluid, “violin string” adhesions of Fitz-Hugh–Curtis syndrome and left hydrosalpinx. Laparoscopic adhesiolysis was performed successfully, and the patient had an uneventful postoperative course. The authors conclude that pelvic inflammatory disease should be included as a cause of adhesive small bowel obstruction in sexually active young women with no history of abdominal surgery or constitutional symptoms of chronic disease. When performed by experienced surgeons, laparoscopy in such patients is feasible and safe.
... The laparoscopic approach is ideal in patients with ASBO who do not have extensive prior abdominal surgeries. The cause can be confirmed, and frequently unexpected pathology can be addressed using advanced laparoscopic skills [20]. Our patient exhibited obstructive symptoms from right upper quadrant adhesions most likely due to Fitz-Hugh-Curtis syndrome. ...
... Our patient exhibited obstructive symptoms from right upper quadrant adhesions most likely due to Fitz-Hugh-Curtis syndrome. Although the definitive cause of her ASBO remains undetermined, this entity has been reported a few times in the literature as a cause of ASBO and it is considered to be rare [20][21][22]. Based on the radiological findings, Chilaiditi syndrome was also entertained as a differential diagnosis, however, this finding is typically incidental and occurs in males [23]. ...
Abstract
Introduction: We present the management of a patient who failed conservative management of adhesive small bowel obstruction (ASBO), which was treated with laparoscopic lysis of adhesions.
Presentation of Case: A 66 year old, hypertensive, diabetic patient with previous gynaecological surgery
presents with symptoms of intestinal obstruction for 2 days. Clinical & radiological features are consistent with the diagnosis of SBO. Conservative treatment was started but the patient failed to show any signs of resolution. Laparoscopic adhesiolysis was successfully performed on thin adhesions between the liver and the anterior abdominal wall (possible Fitz-Hugh Curtis syndrome), which trapped the small bowel. The patient was discharged on day 4 of admission.
Discussion: ASBO is a very common and actual disease and its management deserves great attention.
Although surgeons are hesitant to perform laparoscopy in patients with distended small bowel due to adhesive obstruction, laparoscopic surgery performed by experienced surgeons offers the opportunity of shorter hospital stay, quick recovery and less morbidity, including wound sepsis and incisional hernia when compared with laparotomy.
Conclusion: Minimally invasive surgery (MIS) in ASBO is not standard of care, however, selected patients may benefit from the advantages of this approach. Once the necessary expertises are available, an attempt to treat these patients with MIS may be safe, and as such, should be entertained
... The laparoscopic approach is ideal in patients with ASBO who do not have extensive prior abdominal surgeries. The cause can be confirmed, and frequently unexpected pathology can be addressed using advanced laparoscopic skills [20]. Our patient exhibited obstructive symptoms from right upper quadrant adhesions most likely due to Fitz-Hugh-Curtis syndrome. ...
... Our patient exhibited obstructive symptoms from right upper quadrant adhesions most likely due to Fitz-Hugh-Curtis syndrome. Although the definitive cause of her ASBO remains undetermined, this entity has been reported a few times in the literature as a cause of ASBO and it is considered to be rare [20][21][22]. Based on the radiological findings, Chilaiditi syndrome was also entertained as a differential diagnosis, however, this finding is typically incidental and occurs in males [23]. ...
... The syndrome occurs predominantly in young women, who complain of severe right upper quadrant pain during the acute phase that sometimes simulates pleurisy (1,4). In the chronic phase, numerous viscero-visceral and viscero-parietal adhesions are formed, initiating at Glisson's capsule; such cases are diagnosed using explorative laparotomy or laparoscopy (3,5). In the literature, approximately 12-25% of pelvic inflammatory disease cases occur concomitantly with FHC. ...
Fitz-Hugh-Curtis syndrome is an inflammatory disease of the liver capsule that occurs as a complication of pelvic inflammatory disease in approximately 25% of cases. The most common etiological agents are Chlamydia trachomatis and Neisseria gonorrhoeae. Classically, it manifests as acute right upper quadrant pain, which can sometimes be confused with pyelonephritis or a primitive condition of hepatobiliary origin or the digestive tract. A correct diagnosis is often difficult. Ultrasonography and computed tomography (CT) may be helpful in the differential diagnosis of other forms of peritonitis localized in the right abdominal quadrants, and serology, urine cultures and cervical swabs are generally used to isolate the responsible organism. The differential diagnosis could include Chilaiditi syndrome (interposition of a colonic segment between the liver and diaphragm with occlusion) or exudative peritonitis from salpingitis. We describe the clinical case of a 24-year-old Caucasian woman who presented with acute right upper quadrant pain, positive Murphy's sign, neutrophilic leukocytosis, and fever.
... Si no se realiza la lisis, por lo menos debemos describir la presencia de estas adherencias patognomónicas y advertir a la paciente, ya que se han descrito casos en que se ha confundido dolor de hipocondrio derecho debido a esta causa con enfermedad biliar aguda (26,27). Aunque más infrecuente, también existen publicaciones de casos de obstrucción intestinal debido a estas adherencias (28,29). Por otro lado, en un trauma abdominal, si se rompen, podrían provocar teóricamente un sangrado de la superfi cie hepática, al desgarrar la cápsula. ...
El síndrome de Fitz-Hugh-Curtis es una perihepatitis producida por una peritonitis secundaria al ascenso de bacterias, como resultado de una enfermedad inflamatoria pélvica. En la etapa crónica se pueden observar adherencias entre la pared abdominal y la superficie hepática, caracterizadas por la semejanza a "cuerdas de violín". Esta imagen es considerada criterio diagnóstico. Se presenta un caso de hallazgo de síndrome de Fitz-Hugh-Curtis, pesquisado durante la inspección rutinaria de la cavidad abdominopélvica, al finalizar una histerectomía laparoscópica.
Fitz-Hugh-Curtis syndrome (FHCS), also known as perihepatitis, is a rare complication of pelvic inflammatory disease. It has a different incidence depending on which diagnostic criteria are used. FHCS consists of inflammation of the hepatic capsule and surrounding peritoneum, without involvement of the hepatic parenchyma, due to intraperitoneal dissemination from a pelvic infection. Clinical manifestations are nonspecific and include a sudden onset of pain and discomfort in the right hypochondrium, commonly confused with other hepatobiliary, gastrointestinal or renal diseases. In recent years, multidetector computed tomography has proven to be a very useful and non-invasive tool, which offers diagnostic confidence within the appropriate clinical setting. Radiological diagnosis of FHCS can avoid unnecessary surgical procedures.
The article contains the results of modern diagnosis and successful minimally invasive surgical treatment of a patient with acute commissural intestinal obstruction. Timing of the entrance form the onset of the disease amounted to 24 hours. The reason for treatment at the clinic was the increased pain syndrome, bloating and dyspeptic phenomenon. When ultrasound found, free fluid in the abdominal cavity is not available.
For a more accurate diagnostic topical review was performed X-rays of abdominal cavity, on which Kloyber’s bowls and intestinal arches revealed, which was confirmed by the diagnosis of intestinal impassability. The patient operated using laparoscopic technology. There were no intraoperative complications. The duration of the operation was 45 minutes. Drainage tubes removed on the 3rd day. In the postoperative period, the patient prescribed antibiotics, antispasmodics, colloidal-crystalloid solutions, non-narcotic analgesics and absorbable drugs. The duration of hospitalization was 5 days. During the monitoring inspection within one month, the patient had no any complaints.
