Asian Journal of Case Reports in Surgery

Two Abnormalities in One: A Rare Case of Partial Intrahepatic Gallbladder with Fitz Hugh Curtis Syndrome

Marian E. Izaguirre-Pérez *

Institute for Social Security and Services for State Workers, Regional Hospital “Dr. Valentín Gómez Farías”, Department of Surgery. Zapopan, JAL 45100, Mexico.

Luis M. Flores Chávez

Institute for Social Security and Services for State Workers, Specialty Clinic-Simplified Surgery Center “CE-CECIS”, Department of Surgery. Guadalajara, JAL 44240, Mexico.

Luis A. Rea Bocanegra

Institute for Social Security and Services for State Workers, Specialty Clinic-Simplified Surgery Center “CE-CECIS”, Department of Surgery. Guadalajara, JAL 44240, Mexico.

Adrian A. Salinas Barragán

Institute for Social Security and Services for State Workers, Specialty Clinic-Simplified Surgery Center “CE-CECIS”, Department of Surgery. Guadalajara, JAL 44240, Mexico.

Juan I. Mandujano-Sánchez

Mexican Institute of Social Security, Lomas Verdes Hospital, Department of Trauma. Naucalpan de Juárez, MEX 53150, Mexico.

*Author to whom correspondence should be addressed.

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Abstract

Aim: Present the case of a female patient with chronic upper right quadrant pain that underwent laparoscopy with the findings of Fitz-Hugh-Curtis syndrome with a partial intrahepatic gallbladder and report the clinical importance of the case and the lessons learned, for optimal future treatment.

Presentation of Case: A 55-year-old female presented to the general surgery outpatient clinic, with a history of 1-year-old chronic right upper quadrant pain. It was decided to perform abdominal ultrasound reporting gallstones. She underwent a laparoscopy, findings included perihepatic adhesions between the liver capsule and anterior abdominal wall. The gallbladder had a 70% intrahepatic surface which occasioned a technical difficulty because traction of the gallbladder to improve vision resulted in tearing of the hepatic capsule and, therefore, bleeding of the hepatic bed.

Discussion: It is important to acknowledge the technical difficulties in the cholecystectomy when a Fitz-Hugh-Curtis syndrome is present, this because the violin strings don’t permit the gallbladder retraction, and therefore they must be lysed on both hepatic lobes.

Conclusion: We present a rare case of Fitz-Hugh-Curtis syndrome in a patient with a partial intrahepatic gallbladder. It highlights the need for a better diagnosis approach and imaging methods to achieve better planning and decrease the risk of complications.

Keywords: Intrahepatic gallbladder, Fitz-Hugh-Curtis syndrome, perihepatitis, cholecystitis

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