Case report of peritoneal inclusion cysts successfully treated using the LNG-IUS

Abstract

Peritoneal inclusion cysts (PIC) can occur as a consequence of past abdominal surgeries, trauma, pelvic inflammatory disease, or endometriosis. Various therapeutic modalities have been advocated including adhesiolysis, sclerotherapy, oral contraceptives/low dose estrogen-progestin (OC/LEP), or GnRH agonists. We hereby report a case of persistent PIC successfully treated using the levonorgestrel-releasing intrauterine system (LNG-IUS). The patient was a 44-year-old woman who had undergone surgery on her ileum at the age of nine months. At the age of 31, she complained of pain with abdominal blow and was found to have a large amount of ascites associated with multiple intrapelvic cysts along with uterine fibroids. She then underwent exploratory laparotomy which showed no ovarian cysts but revealed ascites sequestered in an enclosed space formed by abdominal adhesions. On a diagnosis of PIC was made and adhesiolysis was performed on this patient. However, abdominal pain and distension was not improved. The peritoneal-venous shunt surgery was impossible for the risk of shunt closure with viscosity of ascites and absorption has been continued. At the age of 42, ascites was found to be hemorrhagic during her menses. This finding prompted us to recommend the use of the LNG-IUS in this patient on the assumption that the regurgitation of menstrual blood might have been increasing the ascites in the PIC. Shortly after initiating the LNG-IUS therapy the ascites disappeared, and absorption has not been required for over a year. This case report indicates that the use of the LNG-IUS might constitute a conservative treatment option for patients with PIC associated with the regurgitation of menstrual blood.[Adv Obstet Gynecol, 69 (1) : 21-25, 2017 (H29.2)]