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.