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

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

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


Figure 1.
Figure 1. Abdominal X-ray showed moderately distended gas filled loops (white arrow).
Figure 2.
Figure 2. Axial CT image of abdomen and pelvis showed dilated bowels and air-fluid levels (arrows). CT: computed tomography.
Figure 3.
Figure 3. Axial CT image of abdomen and pelvis showed an inflamed appendix (arrows). CT: computed tomography.
Figure 4.
Figure 4. Axial CT image of abdomen and pelvis showed no liver capsular enhancement or hepatomegaly. CT: computed tomography.
Figure 5.
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 caseKhine 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)15162722
SymptomsNausea and vomitingAbdominal painAbdominal painVomiting and abdominal pain
FeverAfebrileAfebrileLow-grade feverFebrile
Location of abdominal painDiffuseLeft lower quadrantRight upper quadrantLower abdomen/right flank
Vaginal dischargeNoneNoneIncreasedVaginal discharge 3 months prior
CT imagingNo peritoneal or capsular enhancementNot reportedaHepatomegaly, capsular enhancement, enlarged appendix with wall thickeningEnlarged appendix with surrounding fat stranding
Pelvic ultrasoundComplex bilateral ovarian cysts and normal reproductive anatomyLeft ovarian massUnremarkableNot reported
Laboratory resultsLeukocytosis, elevated platelets, neutrophilia (80%), and hyponatremiaNot reportedElevated C-reactive protein, elevated WBCElevated C-reactive protein, elevated WBC, neutrophilia
Liver enzymesNot elevatedNot reportedSlightly elevatedNot elevated
Pathogen: N. gonorrhoeae or C. trachomatisC. trachomatisC. trachomatisNegativebC. trachomatis
Laparoscopic findingsChronic thickening of the appendix, adhesions on left and right liver lobesaPID with extensive adhesions, bilateral pyosalpinxes, left ovarian abscess, and perihepatic inflammation with classic violin string signsNo surgical interventionInflammation of appendix, bloody ascites, adhesionsa
Complications SBO and/or appendicitisSBO and appendicitisNot reportedAppendicitisAppendicitis