P3904 - Appendicitis Causing Perihepatitis

Taimur S. Muzammil, MD¹, Muhammad Ali Butt, MD^2
1Allegheny Health Network, Pittsburgh, PA; ²Medicine Institute, Allegheny Health Network, Pittsburgh, PA

Introduction: Fitz Hugh Curtis syndrome (FHCS), also know as perihepatitis is inflammation of the liver capsule with adhesion formation resulting in right upper quadrant pain. We present a rare case where our patient was found to have perihepatitis after appendicitis with no signs or symptoms or lab testing consistent with pelvic inflammatory disease.

Case Description/Methods: 47 year old female with history of mildly elevated LFTs attributed to fatty liver disease presenting with right upper quadrant pain, nausea and vomiting who was diagnosed with acute uncomplicated appendicitis seen on CT abdomen pelvis for which patient underwent laparoscopic appendectomy without complications. Patient was given one dose of piperacillin-tazobactam and ceftriaxone. Imaging demonstrated concern for a hepatic nodule with normal LFTs on admission. MRI Liver was ordered to further evaluate and demonstrated striking circumferential hepatic capsular/perihepatic and occasionally subcapsular enhancement which is characteristic of Fitz Hugh Curtis Syndrome. Patient was seen by obstetrics and gynecology post procedure with the abdominal and pelvic exam noted to be unremarkable. No urinary/vaginal irritation or discharge was endorsed by patient and no history of exposure or high risk sexual activity. Testing for Chlamydia and Gonorrhea was negative and perihepatitis was attributed secondary to appendicitis. Patient remained asymptomatic after appendectomy and further intervention such as laparoscopy was not deemed necessary, patient continues to do well.

Discussion: The gold standard of diagnosis is considered to be laparoscopic examination and direct visualization of adhesions between the liver and diaphragm or liver and the anterior abdominal wall. MRI and CT scan findings are reported to be useful for diagnosis of FHCS but remain poorly described. Treatment is geared towards treating the underlying pelvic inflammatory disease with antibiotics and laparoscopic intervention for symptomatic adhesiolysis. A thorough gynecological workup should be done in patients with Fitz Hugh Curtis syndrome and if negative the possibility of appendicitis causing the radiological finding in a patient with negative workup should be considered in light of this case.



Disclosures:


Taimur S. Muzammil, MD¹, Muhammad Ali Butt, MD². P3904 - Appendicitis Causing Perihepatitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.