陳旧性Fitz-Hugh-Curtis症候群（FHCS）による小腸イレウスを発症した卵巣嚢腫の症例

抄録

Background: Fitz-Hugh-Curtis syndrome (FHCS), or perihepatitis, is a condition associated with pelvic inflammatory disease characterized by perihepatic "violin string" adhesions between the liver capsule and peritoneal surfaces of the anterior right upper quadrant. The acute adhesions of FHCS are known to be a possible cause of ileus. However, reports of ileus caused by obsolete adhesions of FHCS are few.

Case: A 75-year-old woman presented with an abdominal pain that moved from the right quadrant to the lower abdomen. Computed tomography (CT) revealed a left ovarian cyst 18 cm in diameter and a small intestinal obstruction. She was treated conservatively with bowel rest and nasogastric tube decompression; however, her symptoms did not improve with these conservative treatments. On the eighth day, we performed laparoscopic surgery for ileus release and left salpingo-oophorectomy. We found the small intestine fixed above the liver by perihepatic "violin string" adhesions and released the obstruction by pulling out the intestine. After the surgery, because of a previous infection, we tested her for Chlamydia trachomatis antibody. Thus, the ileus turned out to be caused by obsolete FHCS. In addition, the CT scan obtained at hospitalization showed characteristic adhesions between the liver and peritoneal surfaces, which suggested FHCS.

Conclusion: Perihepatic adhesions of FHCS are sometimes found during laparoscopic surgery and can cause obstructive ileus even long after an inflammation. CT is effective in identifying FHCS adhesions.