Reddish-purple areas occasionally found on the surface of the liver have been related to peliosis hepatis. The purpose of the present study was to determine: 1) the frequency of these changes in a total of 3035 laparoscopies and 2) the histological substrate of these laparoscopical changes. In 20 cases (0.65%), reddish-purple patches of round, triangular, star-shaped or net-work configuration were found on the liver surface. Liver biopsies taken from these areas showed: 1) dilatation of sinusoids; 2) blood-filled cavities, and 3) intralobular hemorrhages. These lesions were frequently combined. In three cases no lesions were found. The presence of these histological lesions was compared with those found in a group serving as controls, in whom no reddish-purple spots were seen at laparoscopy. Our study shows that there is a close statistical relationship (X2: 19.01; p less than 0.001) between the histological and laparoscopic changes. We conclude that: 1) Reddish-purple areas on the liver surface are caused by Peliosis hepatis or are Peliosis hepatis-related lesions, and 2) Peliosis hepatis is not an extremely rare condition in laparoscopy.