Perihepatic adhesions are often considered to be associated with pelvic inflammatory disease and subsequent infertility. Seventeen patients out of 100 undergoing elective laparoscopic sterilization had evidence of perihepatic adhesions. Four of the 17 showed evidence of old pelvic inflammatory disease, but only two gave a history of sexually transmitted disease. All patients had a negative gonorrhea culture and 50 also had a negative chlamydia culture before the procedure. These data suggest that perihepatic adhesions may be observed in otherwise normal fertile women, and its presence does not necessarily imply pelvic inflammatory disease or poor fertility.
PIP: 100 consecutive patients undergoing elective laparoscopic tubal ligation were enrolled in a study aimed at investigating the association between perihepatic adhesions and pelvic inflammatory disease (PID). Perihepatic adhesions were identified in 17 of these patients on the basis of evaluation of the liver capsule and anterior abdominal wall. 2 patients (12%) in the adhesions group and 12 (15%) in the no-adhesions group reported a history of sexually transmitted diseases (STDs). No patient with adhesions had a documented PID episode in her history compared with 2 (2%) in the no-adhesions group. 4 patients with adhesions (24%) and 5 (6%) of those with no adhesions had clinical evidence of old pelvic infection. 2 women with a history of STD and adhesions had evidence of chronic pelvic infection. All patients had a negative gonorrhea culture, and all were clinically asymptomatic. The finding that 13 of the 17 patients with perihepatic adhesions had no evidence of prior infection of the pelvis was unexpected and suggests a need for a larger study to define the causes of these adhesions. Also suggested by these findings is the lack of association between perihepatic adhesions and infertility, since all patients were fertile women undergoing interval sterilization.