In the Fitz-Hugh-Curtis syndrome (perihepatitis associated with PID), the characteristic finding that clinches the diagnosis is:
- A Diffuse intraperitoneal free fluid on CT with liver capsule enhancement
- B Violin-string adhesions between anterior liver surface and parietal peritoneum on laparoscopy ✓
- C Elevated transaminases >3× ULN with concurrent cervical discharge
- D Linear echogenicity between liver and diaphragm on transvaginal ultrasound
Explanation
Fitz-Hugh-Curtis syndrome presents with right upper quadrant pain, pleuritic chest pain, and concurrent PID. The pathognomonic laparoscopic finding is 'violin-string' or 'bow-string' adhesions between the anterior surface of the liver (or right lobe) and the anterior parietal peritoneum. These adhesions represent fibrous bands formed after transperitoneal spread of Chlamydia trachomatis or N. gonorrhoeae. Liver enzymes may be mildly elevated but this is not specific. CT may show perihepatic enhancement but is not specific. The diagnosis is clinical with laparoscopy for definitive confirmation. Treatment is the same as for PID with addition of doxycycline for Chlamydia.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.