Pelvic Peritoneal Inclusion Cyst: Ultrasound Diagnosis and Management

Abstract

Pelvic peritoneal inclusion cysts are rarely encountered in practice. We report four cases with pelvic peritoneal inclusion cysts with their management. Female patients with history of abdominal pain and infertility were diagnosed with peritoneal inclusion cyst on ultrasound. They were operated by laparoscopy or laparotomy. 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.