OVERVIEW

What is perihepatitis?

Perihepatitis (Fitz-Hugh-Curtis syndrome) is inflammation of the liver capsule secondary to pelvic infection. It was first identified in the 1920s as the "subcostal syndrome." In 1930, Curtis and Fitz-Hugh separately reported cases of salpingitis caused by gonococcal infection combined with perihepatitis, hence the name "Fitz-Hugh-Curtis syndrome."

Is perihepatitis common?

According to literature, the incidence of this condition among pelvic inflammatory disease (PID) patients ranges from 3% to 25%, with variations across research centers. However, current evidence suggests perihepatitis occurs relatively frequently in patients with pelvic inflammatory disease. Screening, detection, and prevention of perihepatitis in acute PID cases are critically important.

SYMPTOMS

What are the manifestations of perihepatitis?

The typical symptom is persistent right upper abdominal pain following lower abdominal pain, which may radiate to the right shoulder and back. The interval between the onset of lower abdominal symptoms and upper abdominal pain is approximately 1 week, with reports of up to 2 weeks. Some patients may only experience mild lower abdominal pain or even just lower abdominal discomfort, with right upper abdominal pain being the most prominent symptom.
Additionally, patients may have low-grade fever (37°C–38°C), increased vaginal discharge, and other symptoms.

Which diseases is perihepatitis easily misdiagnosed as?

Perihepatitis has a sudden onset and manifests as severe right upper abdominal pain. It needs to be differentiated from acute cholecystitis, gastroduodenal ulcer perforation, and subphrenic abscess:

• The distinction between acute cholecystitis and perihepatitis mainly relies on ultrasound examination. Color Doppler ultrasound can reveal signs of gallbladder inflammation, such as swelling and thickened walls.

• Patients with gastroduodenal ulcer perforation often have a history of upper gastrointestinal ulcers. Abdominal upright X-rays or CT scans can aid in differentiation.

• Patients with subphrenic abscess often exhibit systemic inflammatory responses such as high fever (up to 39°C or above), rapid heart rate, fatigue, and poor appetite. CT or color Doppler ultrasound can detect pus accumulation under the diaphragm.

CAUSES

What are the main pathogens of perihepatitis?

Chlamydia trachomatis is currently considered the primary pathogen of this disease. Additionally, Neisseria gonorrhoeae can also cause it.

Who is commonly affected by perihepatitis?

Perihepatitis mostly occurs in women of childbearing age with pelvic inflammatory disease. Furthermore, patients undergoing procedures such as tubal flushing, induced abortion, or intrauterine device removal may also develop secondary perihepatitis, possibly due to pathogens entering the abdominal cavity during uterine manipulation and ascending to infect the peritoneum surrounding the liver.

DIAGNOSIS

Which department should patients with perihepatitis visit?

Patients should go to the emergency department and provide detailed information to the attending physician about recent abdominal pain history, menstrual history, sexual activity history, and gynecological surgical history. Avoid withholding accurate and comprehensive medical or personal history under the guise of "privacy," as this may delay diagnosis and treatment.

How is perihepatitis diagnosed?

The definitive diagnosis of perihepatitis requires observing inflammatory manifestations on the liver surface through methods like laparoscopy or exploratory laparotomy, along with pathogen detection. However, these invasive procedures are not recommended.

Currently, most cases can be diagnosed through non-invasive methods such as abdominal CT and laboratory tests. Abdominal CT may show thickening of the liver capsule.

Laboratory tests can detect antibodies or nucleic acids of Chlamydia trachomatis or Neisseria gonorrhoeae in vaginal/cervical secretions or serum. Since the disease is confined to the peritoneum surrounding the liver and rarely involves the liver parenchyma, liver function tests are usually normal, particularly with normal or only mildly elevated transaminases.

TREATMENT

How should perihepatitis be treated?

The key to treating perihepatitis lies in the timely and effective use of antibacterial drugs. The primary targets are Chlamydia trachomatis and Neisseria gonorrhoeae. First-line treatments include tetracyclines and macrolide antibiotics, such as tetracycline, doxycycline, and azithromycin.

For severe cases unresponsive to medication, such as those with significant perihepatic or pelvic adhesions, laparoscopic adhesiolysis may be performed. This involves thorough irrigation of the abdominal and pelvic cavities during surgery, followed by targeted antibiotic therapy based on pathogen identification and susceptibility testing.

Can perihepatitis be cured? What complications may occur?

Most patients can recover fully.

Perihepatitis is a complication of pelvic inflammatory disease, primarily involving inflammation and adhesion formation around the liver without parenchymal damage. With appropriate antibiotics and control of pelvic inflammation, most patients achieve complete recovery. However, severe complications may still arise in some cases:

• Infertility and ectopic pregnancy are common in patients with pelvic inflammatory disease or perihepatitis, primarily linked to Chlamydia trachomatis infection. Chronic infection damages fallopian tube structure and function while altering the pelvic microenvironment, impairing conception and embryo development.

• In perihepatitis, adhesions between the liver surface, abdominal wall, and intestines may hinder resolution or colonic motility, leading to partial bowel obstruction. Severe cases may progress to complete obstruction or intestinal necrosis.

DIET & LIFESTYLE

What precautions should patients with perihepatitis take in daily life?

• Patients with perihepatitis often have varying degrees of pelvic inflammatory disease. Therefore, they should maintain stricter hygiene practices, avoid unsafe sexual activity (use condoms whenever possible and refrain from sexual contact with suspected infected individuals), change and wash underwear frequently, and pay attention to intimate hygiene;

• Patients who have undergone induced abortion should strengthen postoperative care, engage in appropriate exercise, and boost their immune resistance;

• In terms of diet, maintain a light diet, actively supplement protein, and avoid alcohol;

• Take medications on time as prescribed by the doctor.

PREVENTION

Can perihepatitis be prevented?

Standardized treatment of pelvic inflammatory disease can help prevent this condition. For details, see the entry on "Pelvic Inflammatory Disease".