Recurrent Peritoneal Inclusion Cyst With Persistent Pelvic Pain Despite Radiologic Improvement: A Management Challenge.

Peritoneal inclusion cysts (PICs) are benign cystic lesions that most commonly occur in women with a history of prior abdominal surgery, endometriosis, or pelvic inflammatory disease. They arise from the accumulation of peritoneal fluid within adhesions and are associated with high recurrence rates despite available treatment options. We present the case of a 43-year-old woman with a history of prior abdominal surgery who developed recurrent PICs associated with persistent pelvic pain. Imaging demonstrated a large multiloculated pelvic cystic lesion, and pathologic examination confirmed a benign peritoneal inclusion cyst. The patient underwent surgical excision followed by image-guided drainage and alcohol sclerotherapy for recurrent disease. Although follow-up imaging demonstrated interval reduction in cyst size without concerning radiologic features, she continued to experience significant pelvic pain requiring ongoing management. This case highlights the challenges associated with recurrent PICs and demonstrates that radiographic improvement may not necessarily correlate with symptom resolution. Clinicians should consider both imaging findings and patient-reported symptoms when evaluating treatment response and managing recurrent disease.