J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://www.journalmc.org

Case Report

Volume 13, Number 7, July 2022, pages 335-340

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

Figure 2. Axial CT image of abdomen and pelvis showed dilated bowels and air-fluid levels (arrows). CT: computed tomography.

Figure 3. Axial CT image of abdomen and pelvis showed an inflamed appendix (arrows). CT: computed tomography.

Figure 4. Axial CT image of abdomen and pelvis showed no liver capsular enhancement or hepatomegaly. CT: computed tomography.

Figure 5. Abdominal X-ray on the next day showed resolving distention of small bowel loops (white arrow).

**Table 1.** Literature Review of Case Reports Documenting Fitz-Hughs-Curtis Syndrome Complicated by Appendicitis and/or SBO
	Current case	Khine et al, 2019 [10] (case 1)	Kazama et al, 2013 [11]	Ishimaru et al, 2021 [12]
^aPatient was diagnosed with Fitz-Hughs-Curtis syndrome during a laparoscopic examination. ^bPatient was treated empirically for C. trachomatis with azithromycin and levofloxacin based on CT imaging findings prior to specimen collection. SBO: small bowel obstruction; CT: computed tomography; WBC: white blood cell; N. gonorrhoeae: Neisseria gonorrhoeae; C. trachomatis: Chlamydia trachomatis; PID: pelvic inflammatory disease.
Age (years)	15	16	27	22
Symptoms	Nausea and vomiting	Abdominal pain	Abdominal pain	Vomiting and abdominal pain
Fever	Afebrile	Afebrile	Low-grade fever	Febrile
Location of abdominal pain	Diffuse	Left lower quadrant	Right upper quadrant	Lower abdomen/right flank
Vaginal discharge	None	None	Increased	Vaginal discharge 3 months prior
CT imaging	No peritoneal or capsular enhancement	Not reported^a	Hepatomegaly, capsular enhancement, enlarged appendix with wall thickening	Enlarged appendix with surrounding fat stranding
Pelvic ultrasound	Complex bilateral ovarian cysts and normal reproductive anatomy	Left ovarian mass	Unremarkable	Not reported
Laboratory results	Leukocytosis, elevated platelets, neutrophilia (80%), and hyponatremia	Not reported	Elevated C-reactive protein, elevated WBC	Elevated C-reactive protein, elevated WBC, neutrophilia
Liver enzymes	Not elevated	Not reported	Slightly elevated	Not elevated
Pathogen: N. gonorrhoeae or C. trachomatis	C. trachomatis	C. trachomatis	Negative^b	C. trachomatis
Laparoscopic findings	Chronic thickening of the appendix, adhesions on left and right liver lobes^a	PID with extensive adhesions, bilateral pyosalpinxes, left ovarian abscess, and perihepatic inflammation with classic violin string signs	No surgical intervention	Inflammation of appendix, bloody ascites, adhesions^a
Complications SBO and/or appendicitis	SBO and appendicitis	Not reported	Appendicitis	Appendicitis

Table 1. Literature Review of Case Reports Documenting Fitz-Hughs-Curtis Syndrome Complicated by Appendicitis and/or SBO

Current case

Khine et al, 2019 [10] (case 1)

Kazama et al, 2013 [11]

Ishimaru et al, 2021 [12]

^aPatient was diagnosed with Fitz-Hughs-Curtis syndrome during a laparoscopic examination. ^bPatient was treated empirically for C. trachomatis with azithromycin and levofloxacin based on CT imaging findings prior to specimen collection. SBO: small bowel obstruction; CT: computed tomography; WBC: white blood cell; N. gonorrhoeae: Neisseria gonorrhoeae; C. trachomatis: Chlamydia trachomatis; PID: pelvic inflammatory disease.

Age (years)

Symptoms

Nausea and vomiting

Abdominal pain

Vomiting and abdominal pain

Fever

Afebrile

Low-grade fever

Febrile

Location of abdominal pain

Diffuse

Left lower quadrant

Right upper quadrant

Lower abdomen/right flank

Vaginal discharge

None

Increased

Vaginal discharge 3 months prior

CT imaging

No peritoneal or capsular enhancement

Not reported^a

Hepatomegaly, capsular enhancement, enlarged appendix with wall thickening

Enlarged appendix with surrounding fat stranding

Pelvic ultrasound

Complex bilateral ovarian cysts and normal reproductive anatomy

Left ovarian mass

Unremarkable

Not reported

Laboratory results

Leukocytosis, elevated platelets, neutrophilia (80%), and hyponatremia

Not reported

Elevated C-reactive protein, elevated WBC

Elevated C-reactive protein, elevated WBC, neutrophilia

Liver enzymes

Not elevated

Not reported

Slightly elevated

Not elevated

Pathogen: N. gonorrhoeae or C. trachomatis

C. trachomatis

Negative^b

C. trachomatis

Laparoscopic findings

Chronic thickening of the appendix, adhesions on left and right liver lobes^a

PID with extensive adhesions, bilateral pyosalpinxes, left ovarian abscess, and perihepatic inflammation with classic violin string signs

No surgical intervention

Inflammation of appendix, bloody ascites, adhesions^a

Complications SBO and/or appendicitis

SBO and appendicitis

Not reported

Appendicitis