Barahmeh Samer, Shrateh Oadi N, Hamarsheh Lyudmila, Tanib Iyas
Department of Obstetrics and Gynecology, Al-Istishari Arab Hospital, Ramallah, Palestine.
Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
Int J Surg Case Rep. 2023 Dec;113:109043. doi: 10.1016/j.ijscr.2023.109043. Epub 2023 Nov 14.
Peritoneal inclusion cysts (PICs) are infrequently encountered cysts within the abdominal and pelvic regions, typically observed in perimenopausal women. They frequently pose a diagnostic challenge as they can be clinically misinterpreted as ovarian-related lesions, owing to their resembling clinical presentations and radiological features.
A 30-year-old female patient without significant medical or surgical history sought medical attention for mild left lower abdominal discomfort lasting two days. Initial evaluation ruled out pregnancy, and further tests showed no abnormalities in her blood work. Pelvic ultrasound revealed a 4.5 cm cystic mass in her left ovary while her right ovary and uterus appeared normal. A laparoscopic ovarian cystectomy was planned. During the procedure, it was discovered that the mass was not connected to the left ovary but was, in fact, a peritoneal inclusion cyst. CLINICAL DISCUSSION: previous intraperitoneal surgeries performed within a timeframe ranging from 6 months to 20 years, intraperitoneal inflammation, pelvic inflammatory disease, peritoneal tuberculosis, leiomyoma, tubo-ovarian abscess, among others. However, the absence of these predisposing factors does not minimize the possibility of PICs.
This case highlights the diagnostic challenges and the value of laparoscopy in accurately identifying and differentiating such cystic cases.
腹膜包涵囊肿(PICs)是腹盆腔内较少见的囊肿,多见于围绝经期女性。由于其临床表现和影像学特征相似,常被临床误诊为卵巢相关病变,因此常给诊断带来挑战。
一名30岁女性患者,无重大内科或外科病史,因持续两天的轻度左下腹部不适前来就医。初步评估排除了妊娠,进一步检查显示其血液检查无异常。盆腔超声检查发现左侧卵巢有一个4.5厘米的囊性肿物,而右侧卵巢和子宫外观正常。计划进行腹腔镜卵巢囊肿切除术。手术过程中发现该肿物与左侧卵巢不相连,实际上是一个腹膜包涵囊肿。
既往腹腔内手术在6个月至20年的时间范围内进行,腹腔内炎症、盆腔炎、腹膜结核、平滑肌瘤、输卵管卵巢脓肿等。然而,这些易感因素的不存在并不能降低PICs的发生可能性。
本病例突出了诊断挑战以及腹腔镜在准确识别和鉴别此类囊性病例中的价值。