fitz  hugh  curtis syndrome is an extra - pelvic manifestation of pelvic inflammatory disease ( pid ) and is characterized by perihepatic adhesions between liver capsule and diaphragm or anterior peritoneal surface(13 ) .
most fitz  hugh  curtis syndrome patients are women of child bearing age and rarely has the syndrome been reported in males .
the predominant symptom is pain in the right upper quadrant , which may be confused with biliary disease
an abdominal computed tomography ( ct ) scan may reveal subcapsular enhancement of the liver in arterial phase ( 4 ) . we herein report a case of fitz  hugh  curtis syndrome in a male patient that was diagnosed via laparoscopy .
a 29 year - old african american male with russel - silver dwarfism presented with one day history of diarrhea , nausea , vomiting , right side abdominal pain , and abdominal distention .
the pain was constant , gradually increasing in severity , and not related to food intake .
his medical history was significant for russel - silver dwarfism , calcium deficiency , cardiomegaly , and bilateral testicular implants for undescended testicles .
the patient was sexually active only with his girlfriend and denied any history of sexually transmitted disease . on examination patient was afebrile and his vitals were stable .
laboratory workup revealed white blood cell ( wbc ) count of 14,000/l with normal liver function tests .
ct scan of the abdomen and pelvis showed a small amount of free fluid in pelvis ; the proximal appendix appeared normal , however the distal appendix was not visualized .
the liver capsule appeared normal and there was no subcapsular fluid collection ( figure 1 ) .
ct scan showing normal appearing liver capsule and no perihepatic fluid collection the patient was admitted to the surgical service .
he was made nil per os ( npo ) , and placed on intravenous fluids and pain medication .
he was refusing any surgical intervention at this point . on hospital day 5 , a repeat abdominal ct scan demonstrated a normal appearing liver , small bowel , large bowel , and appendix , with a mild increase in pelvic free fluid .
as the patient 's symptoms did not improve with conservative management , he ultimately agreed to undergo a diagnostic laparoscopy , and was taken to the operating room on hospital day 9 .
the small bowel was run in a retrograde fashion starting at the caecum , and no stricture , mass , or perforation was noticed .
appendectomy was not performed as per patient'swishes . following the procedure , the patient reported complete resolution of his symptoms .
his diet was gradually advanced , which he tolerated well , and was discharged on post operative day 2 .
fitz -hugh  curtis syndrome was first described in 1920 by carlos stajano . in the 1930 's thomas fitz 
hugh and arthur curtis also described the syndrome and made a connection between right upper quadrant pain following a pelvic infection and violin  string like perihepatic adhesions(5 ) . the first case of gonococcal perihepatitis in a male
the incidence ranges from 4% to 14% in women with pid , but is as high as 27% in adolescents with pid , whose less mature genitourinary tract anatomy makes them more susceptible to infection(1 ) .
the inflammation of the liver capsule has been attributed to the direct bacterial spread from an infected fallopian tube via the right paracolic gutter . in men , hematogenous and lymphatic spread to liver
the predominant symptoms are right upper quadrant pain , tenderness , and pleuritic right sided chest pain(2 ) .
these symptoms can pose diagnostic challenges as they may be confused with biliary tract symptoms . in a clinical setting ,
the diagnosis is adequately established by excluding other possible causes of right upper quadrant pain . on laboratory examination ,
white blood cell count can be elevated in nearly half of the patients , while liver function tests are normal in most patients . because urethral cultures frequently fail to demonstrate the presence of gonorrhea and chlamydia , the serologic microimmunofluorescence antibody test is helpful in diagnosis ( 2 ) .
ct scan may show subcapsular fluid collection , thickening of hepatic capsule in the arterial phase , and wedging enhancement of the involved liver parenchyma in more than 50% of patients .
most cases of fitz  hugh  curtis syndrome are managed with antibiotics against gonorrhea and chlamydia .
it occurs mostly in premenopausal women , however , cases in males have also been reported .
 fitz  hugh  curtis syndrome is a condition characterized by inflammation of the liver capsule with concomitant pelvic inflammation without involvement of liver parenchyma . 
 it is classically seen in young women who present with sharp , pleuritic right upper quadrant pain , usually but not always accompanied by symptoms of pelvic inflammatory disease ( pid ) and is frequently confused with biliary tract disease . rarely the syndrome has been reported in males , hematogenous and lymphatic spread to liver is thought to be the underlying mechanism . 
 serological tests and computed tomography ( ct ) scan may aid in diagnosis of fitz  hugh  curtis syndrome . 
 definitive diagnosis is made by laparoscopy , which provides both diagnostic and therapeutic benefits . 
 we report a case of fitz  hugh  curtis syndrome in a young male patient , which was diagnosed and treated by laparoscopy . 
 we also include a review of the literature . 
INTRODUCTION
CASE REPORT
DISCUSSION