What is the significance of violin string adhesions in Fitz-Hugh-Curtis syndrome (Fitz-Hugh-Curtis syndrome), a condition characterized by perihepatitis?

From the Guidelines

Fitz-Hugh-Curtis syndrome is a condition where violin string adhesions are a significant finding, resulting from the spread of genital tract infections to the peritoneal cavity, and treatment should focus on addressing the underlying infection and managing peritoneal inflammation. The condition is characterized by perihepatitis, which is an infection of the liver capsule, and is often associated with pelvic inflammatory disease (PID) 1. The violin string adhesions appear as thin, fibrous strands resembling violin strings and are typically found during laparoscopy or laparotomy.

Key points to consider in the management of Fitz-Hugh-Curtis syndrome include:

• The underlying cause of the condition is usually a sexually transmitted infection, such as Chlamydia trachomatis or Neisseria gonorrhoeae 1
• Treatment should involve addressing the underlying infection with appropriate antibiotics, such as doxycycline or ceftriaxone plus azithromycin 1
• Managing the peritoneal inflammation with anti-inflammatory medications is also crucial
• Early diagnosis and treatment are essential to prevent chronic pain and potential fertility issues

The significance of violin string adhesions in Fitz-Hugh-Curtis syndrome lies in their association with the spread of genital tract infections to the peritoneal cavity, which can lead to chronic pain and fertility issues if left untreated 1. Therefore, prompt recognition and treatment of the underlying infection and peritoneal inflammation are critical to improving outcomes and quality of life for patients with Fitz-Hugh-Curtis syndrome.

From the Research

Significance of Violin String Adhesions in Fitz-Hugh-Curtis Syndrome

The significance of violin string adhesions in Fitz-Hugh-Curtis syndrome is a key aspect of diagnosing this condition.

• These adhesions are characterized as fibrinous strands between the anterior liver capsule and the anterior abdominal wall, resembling violin strings 2, 3.
• The presence of these adhesions is a diagnostic feature of Fitz-Hugh-Curtis syndrome, which can be visualized through laparoscopy 2, 3.
• Laparoscopy not only helps in diagnosing the condition by revealing the violin-string-like adhesions but also allows for the resection of these adhesions in the same session 2.

Diagnostic Challenges

Diagnosing Fitz-Hugh-Curtis syndrome can be challenging due to its nonspecific clinical presentation and imaging findings.

• The syndrome often presents with right upper quadrant pain, fever, nausea, and vomiting, which can be confused with other conditions like acute cholecystitis or pleurisy 3, 4.
• Imaging data, such as ultrasound and CT scans, may show intra-abdominal changes but are often nonspecific, making it difficult to suspect Fitz-Hugh-Curtis syndrome initially 3, 5, 6.
• The diagnosis is typically confirmed through the isolation of Neisseria gonorrhoeae or Chlamydia trachomatis, and the presence of violin string adhesions on laparoscopy 2, 3, 5, 6.

Treatment and Outcome

The treatment of Fitz-Hugh-Curtis syndrome involves the use of antibiotics, which can lead to a favorable outcome.

• Antibiotics such as tetracycline, doxycycline, and ofloxacine have been shown to be effective in treating the syndrome 2.
• Prompt antibiotic therapy can lead to the complete resolution of symptoms within a few days 6.
• In some cases, laparoscopy may be necessary not only for diagnosis but also for the resection of adhesions, which can contribute to the resolution of symptoms 2.