In endometrial tuberculosis causing infertility, the Asherman syndrome-like intrauterine adhesions develop through a specific pathological mechanism. The Fitz-Hugh–Curtis syndrome associated with PID involves what specific pathological process in the liver?
- A Haematogenous spread of Chlamydia trachomatis to hepatic parenchyma causing granuloma formation
- B Ascending lymphatic spread of Neisseria gonorrhoeae to porta hepatis causing cholangitis
- C Perihepatitis — inflammation of the liver capsule (Glisson's capsule) causing perihepatic adhesions ('violin string' adhesions) from transperitoneal spread of N. gonorrhoeae or C. trachomatis ✓
- D Direct extension of tubo-ovarian abscess to right hepatic lobe through the right paracolic gutter
Explanation
Fitz-Hugh–Curtis syndrome is perihepatitis complicating PID, occurring in 10–20% of women with PID. Organisms (principally Chlamydia trachomatis, less commonly Neisseria gonorrhoeae) spread transperitoneally from the fallopian tubes to the liver capsule (Glisson's capsule), causing inflammation and subsequent formation of 'violin string' adhesions between the liver capsule and anterior abdominal wall. Clinically it presents as right upper quadrant pain (sometimes severe) with systemic signs of PID. Laparoscopy reveals the characteristic perihepatic adhesions. Treatment is the same as for PID.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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