Pelvic Peritoneal Inclusion Cyst: Ultrasound Diagnosis and Management

In: Indian Journal of Gynecologic Oncology · 2017 · vol. 15(2) · doi:10.1007/s40944-017-0116-2 · W2606877572
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Four female patients with abdominal pain and infertility were diagnosed with rare pelvic peritoneal inclusion cysts via ultrasound and subsequently treated surgically.

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This paper reports four female cases of pelvic peritoneal inclusion cysts presenting with abdominal pain and infertility, diagnosed preoperatively by ultrasound as an irregular, separable cyst-like structure from the ovary. The authors managed patients surgically via laparoscopy or laparotomy, describing deroofing/marsupialization and avoiding cyst dissection to reduce injury to retroperitoneal structures, with an alternative of ultrasound-guided aspiration under sedation. The paper notes that these cysts are rare and relates them to endometriosis and adhesions from prior surgeries or infections, while also stating that recurrence risk is higher with persistent conservative management. This paper is centrally about endometriosis — it explicitly states that pelvic peritoneal inclusion cysts are related to endometriosis and provides diagnostic and management details in cases where such association is considered.

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Abstract

Background Pelvic peritoneal inclusion cysts are rarely encountered in practice. Purpose We report four cases with pelvic peritoneal inclusion cysts with their management.

Methods

Female patients with history of abdominal pain and infertility were diagnosed with peritoneal inclusion cyst on ultrasound.

Results

They were operated by laparoscopy or laparotomy.

Conclusions

Peritoneal cysts are rare in practice. They are related to endometriosis and adhesions of previous surgeries or infections. They are diagnosed on ultrasound by irregular cyst-like structure separable of the ovary. It is better to be surgically removed to avoid recurrence especially if persistent on conservative management. During surgery deroofing is needed with marsupilization with out dissection of the cyst to avoid retroperitoneum structures injury or ultrasound guided aspiration under sedation. If diagnosis is missed on ultrasound, during surgery it is suspected by puncture and evaluation of the cavity for normal peritoneum of douglas pouch with separable ovary or thin transparent cyst wall with no plane of separation for dissection from roof especially if frozen pelvis by adhesions. It is in opposite to the thick wall of ovarian tissue on cystectomy with identifiable plane of dissection. Similar content being viewed by others

References

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