A 37-year-old gravida 7 para 2-0-5-2 woman presented for scheduled bilateral salpingectomy with desired surgical sterilization. Her medical history included normal spontaneous vaginal delivery 6 weeks prior and Trichomonas vaginalis infection treated before pregnancy. The patient reported no past abdominal surgery or additional sexually transmitted infections. Laparoscopic intra-abdominal examination revealed numerous “violin-string” adhesions to the anterior surface of the liver, with an otherwise normal-appearing liver capsule and gall bladder (image A). Extensive adhesions also involved the omentum, small and large bowel, uterus, and bilateral adnexa (image B). 

Fitz-Hugh Curtis syndrome, or perihepatitis, occurs in approximately 10% of women with acute pelvic inflammatory disease and is often asymptomatic with chronic infections.^1,2 Perihepatitis can manifest as a patchy, purulent, and fibrinous exudate (violin string adhesions) on laparoscopy. It most prominently affects the anterior surfaces of the liver, sparing the liver parenchyma, and is not associated with prominent liver dysfunction.³ The patient had successful bilateral salpingectomy with lysis of adhesions and an uncomplicated postoperative course.