Laparoscopic adhesiolysis and marsupialization of a rapidly progressing pelvic pseudocyst

Abstract

Pelvic inflammatory cyst, also known as pelvic inclusion cyst, is usually caused by postsurgical pelvic adhesions [1]. Peritoneal fluid and adnexa are entrapped in adhesions and form a pseudocyst, without true cystic walls, with complex appearance. A large, complex pelvic inflammatory cyst can simulate ovarian malignancy and requires laparotomy for maximal debulking surgery. Ultrasound-guided aspiration is the treatment of choice for minimally invasive management of benign cysts; however, recurrence is quite common and repeated aspirations are inevitable, causing considerable morbidity. Laparotomy can definitively resolve the problem of recurrence, but surgeons tend to avoid this procedure because of additional problems such as the need for a wide abdominal incision, wound infection, postoperative pain, postoperative ileus, and adhesion reformation [2]. Laparoscopic surgery is rapidly replacing laparotomy for many gynecologic surgical conditions because of less tissue reaction, better cosmetic results, and shorter hospitalization period. This approach reportedly yields good results for peritoneal and intra-abdominal adhesions [3]. Some authors have indicated a reduction in adhesion formation after laparoscopic surgery compared with open surgery [2]. Here, we present a case of a rapidly progressing pelvic pseudocystmimicking ovarian malignancy in a 41-year-old nulligravida woman who was successfully managed by laparoscopic adhesiolysis and marsupialization. We specifically described our surgical procedures to offer a manner in laparoscopic approach to extensive pelvic cyst.