The Fitz-Hugh-Curtis syndrome (perihepatitis) as a complication of PID is caused by which pathogen most commonly, and what is its characteristic finding on laparoscopy?

• A Chlamydia trachomatis most commonly; 'violin string' adhesions between the anterior hepatic surface and anterior abdominal wall ✓
• B Neisseria gonorrhoeae exclusively; fibrinous perihepatitis covering the liver capsule
• C Mixed anaerobes; green-yellow bile staining of the hepatic capsule with friable adhesions
• D Actinomyces israelii; sulfur granule deposits on the liver surface

Explanation

Fitz-Hugh-Curtis syndrome is perihepatitis complicating PID, presenting as right upper quadrant pain with pleuritic character in a young woman with cervicitis/PID. It is most commonly associated with Chlamydia trachomatis (though originally described with gonococcal PID). Laparoscopy shows characteristic 'violin string' or 'piano wire' adhesions (filmy fibrous adhesions) between the anterior liver surface (Glisson's capsule) and the anterior abdominal wall. These adhesions develop from acute fibrinous perihepatitis that subsequently organizes. LFTs are usually normal. Treatment is standard PID antibiotics covering Chlamydia (doxycycline); adhesions rarely require lysis.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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