It has long been my custom to make a thorough survey of the abdominal contents whenever the abdomen is opened by free incision. Despite this routine procedure, it was not until approximately five years ago that I became aware of the frequent incidence of adhesions of the anterior surface of the liver in patients with gonorrheal disease of the fallopian tubes.
In 19301 I recorded having encountered more than a dozen instances of liver-abdominal wall, "violin-string" adhesions in patients with coincident residual gonococcal tubal disease. It was characteristic of the adhesions in those cases that they were limited to the anterior surface of the liver; the remainder of the upper part of the abdomen tended to remain free.
During the two years that have elapsed since my earlier report, an accurate record has been kept of the intra-abdominal status of all patients subjected to abdominal operation. In this more