A 20-Centimeter Peritoneal Inclusion Cyst Presenting as Vaginal Prolapse

Area of Science:

• Gynecologic Surgery
• Minimally Invasive Procedures
• Pelvic Floor Reconstruction

Background:

• Large peritoneal inclusion cysts can present atypically, mimicking pelvic organ prolapse.
• Vaginal bulge symptoms and posterior prolapse necessitate thorough diagnostic evaluation, including advanced imaging.
• Surgical management is often required for symptomatic or large cysts impacting pelvic structures.

Observation:

• A 44-year-old woman presented with significant vaginal prolapse due to a 20-cm peritoneal inclusion cyst.
• Dynamic MRI revealed the cyst's extensive involvement of pelvic anatomy.
• Robotic-assisted laparoscopy identified stage-IV endometriosis and the large cyst.

Findings:

• The cyst was successfully mobilized and excised via retroperitoneal dissection.
• Laparoscopic plication of the posterior vaginal wall and peritoneal closure were performed.
• The procedure resolved the prolapse and restored normal pelvic anatomy.

Implications:

• Laparoscopic excision of large peritoneal inclusion cysts is feasible and effective.
• Minimally invasive repair of pelvic floor defects, including posterior vaginal wall plication, can be achieved laparoscopically.
• This approach avoids vaginal incisions for high posterior defects, offering improved visualization and access.