Perihepatic Adhesions: Another Look

OBJECTIVE The objective of our study was to determine if pelvic inflammatory disease (PID) was the only cause of perihepatic adhesions. METHODS One hundred consecutive patients undergoing elective sterilization by laparoscopy were enrolled in this study. The preoperative workup included a history, physical examination, cervical culture for Neisseria gonorrhoeae and Chlamydia trachomatis, leukocyte count, C-reactive protein, and liver-function tests. During the laparoscopic procedure, the pelvis and liver surface were inspected for evidence of any adhesions. If perihepatic adhesions were discovered in a patient without any evidence of prior PID, then cultures from the adhesion, peritoneal fluid, and tubal specimens were obtained for N. gonorrhoeae, C. trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, anaerobes, and facultative aerobes. Tubal specimens were also obtained for histologic examination. RESULTS Of 100 patients, 7 patients had perihepatic adhesions without any laparoscopic evidence of prior PID. The preoperative cultures were negative. Three of these patients had no history of sexually transmitted disease or PID. Their anti-chlamydial antibody titers were also negative. Of the remaining 4 patients with perihepatic adhesions, 2 had a history of gonococcal or chlamydial infection and 2 had histological evidence of chronic salpingitis. CONCLUSIONS The study suggests that PID may not be the only cause of perihepatic adhesions.