When patients present symptoms of chronic pain referable to the right upper quadrant with acute exacerbations, one immediately thinks of a diseased biliary or genito-urinary tract and possibly a gastric or duodenal ulcer associated with chronic pancreatitis. If these are excluded, one's attention is directed to the cardiovascular or central nervous system or to diseases of the vertebral column; if after careful clinical and laboratory studies no cause can be found to account for the pain, the patient may be considered a psychoneurotic.
Curtis1 recently called attention to adhesions in the right upper quadrant as a sequela of a gonorrheal infection in females. He describes them as violin string or banded adhesions occurring between the anterior surface of the liver and the anterior abdominal wall. In the case I encountered in which the operation was performed before Curtis published his recent observations, the adhesions were between the liver and
Hinton JW. HEPATODIAPHRAGMATIC ADHESIONS AS A CAUSE OF UPPER ABDOMINAL PAIN. JAMA. 1930;95(23):1744–1745. doi:10.1001/jama.1930.27210230003010c