Small Bowel Obstruction and Appendicitis in Patient With Fitz-Hughes-Curtis Syndrome

Abstract

Fitz-Hughs-Curtis syndrome is a manifestation of pelvic inflammatory disease (PID) which begins with sexually transmitted organisms such as Chlamydia trachomatis (C. trachomatis) and, less commonly Neisseria gonorrhoeae. The infection is hypothesized to disseminate into the peritoneum via lymphatic, hematogenous, or ascending spread of the organisms. Progression of the disease can result in liver capsule inflammation (perihepatitis) and adhesion formation between organs. This case presentation illustrates a female who presented with symptomology consistent with small bowel obstruction (SBO) and acute appendicitis. The patient was incidentally found to have Fitz-Hugh-Curtis syndrome during laparoscopic surgery, as noted by adhesions on peritoneal organs. These findings prompted a sexually transmitted infection (STI) screening which confirmed a C. trachomatis infection, completing the clinical picture for Fitz-Hugh-Curtis syndrome. This case report highlights the need for an increased index of suspicion for Fitz-Hugh-Curtis syndrome in a young female who presents with right upper quadrant (RUQ) pain in order to prevent future complications of PID, including infertility.

Keywords: Adolescent medicine; Atypical appendicitis; Fitz-Hughes-Curtis syndrome; Long-term complication; Pelvic inflammatory disease; STI; Sexually transmitted disease; Small bowel obstruction.