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

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.