Peritoneal inclusion cyst presenting as an umbilical hernia: case report and systematic review of the literature

Our plain-English summary of Peritoneal inclusion cyst presenting as an umbilical hernia: case report and systematic review of the literature, by K. Nightingale, E. Clough, P. Goldsmith, et al (Journal of Surgical Case Reports, 2024).

The study

• Authors: K. Nightingale, E. Clough, P. Goldsmith, J.R. Burke
• Journal: Journal of Surgical Case Reports
• Published: 2024;2024(5):rjae258
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Peritoneal inclusion cysts (PICs) are a rare and benign condition of uncertain pathogenesis. The fluid-filled, mesothelial-lined cysts manifest within the abdominopelvic cavity. This case report details an unusual occurrence of a 97 mm PIC- presenting as an umbilical hernia- in a 26-year-old male patient with no prior surgical history. Following pre-operative cross-sectional imaging, this was managed through open excision without complication. A systematic review of the literature highlighted 30 previous cases [26F, 4M] with a mean age of 34 years (std ±15.4) and a median diameter of 93 mm [IQR, 109 mm]. A total of 53% (n = 16) of cases had a history of previous abdominal surgery. Surgical excision is safe and laparoscopic modality should be considered (<1% recurrence). Accepting the limited evidence base, image guided drainage should be avoided (50% recurrence, n = 2).

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.

In plain English

This article reported one patient and systematically reviewed published cases of peritoneal inclusion cysts. These are rare, benign, fluid-filled cysts lined with mesothelial cells inside the abdomen and pelvis, also called multicystic peritoneal mesotheliomas. The article does not discuss asbestos. The patient was a 26-year-old man with no previous medical or surgical history. He had intermittent pain and a soft swelling at the navel that examination found consistent with a true umbilical hernia. Scans showed a cyst of 95 mm by 87 mm by 97 mm, which was removed in an open operation. Tissue examination showed no evidence of neoplasia (abnormal tissue growth), and he was discharged without complication. The review found 30 earlier published cases (26 female, 4 male; mean age 34 years), and 16 (53%) had previous abdominal surgery. Of 2 cases drained under imaging guidance, 1 recurred. Of the surgically removed cases, 1 recurred. The authors concluded this was the first documented case arising from the umbilical cicatrix (the navel scar), and that existing literature supports surgical removal rather than drainage, while acknowledging a limited evidence base.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of one patient combined with a systematic review of published case reports
• Who was studied: One 26-year-old man with no previous medical or surgical history, seen in a general surgery outpatient clinic (authors based in Manchester, United Kingdom). The review covered 30 previously published cases found in MEDLINE and EMBASE, searched for articles published between 1 January 1947 and 1 January 2024.
• Exposure: No asbestos or other exposure was studied. The article concerns the presentation, imaging, treatment and recurrence of peritoneal inclusion cysts.
• Main results:
  • In the patient, examination found a positive cough impulse consistent with a true umbilical hernia.
  • In the patient, ultrasound showed a thin-walled fluid collection measuring 95 mm by 87 mm by 97 mm. CT showed a bilobed cystic mass with part of the cyst herniating along the umbilicus.
  • During surgery on the patient, the hernia neck and the root of the cyst were found at the base of the umbilical cicatrix, with no attachment to the mesentery.
  • In the patient, histology showed a mesothelial cell lining with no significant atypia. The diagnosis was peritoneal inclusion cyst with no evidence of neoplasia, and he was discharged without complication.
  • The review included 30 published cases (26 female, 4 male), with a mean age at presentation of 34 years (standard deviation 15.4) and a median diameter of 93 mm (IQR 109 mm).
  • Among the 30 reviewed cases, 53% (n = 16) had a history of previous abdominal surgery.
  • Among the 30 reviewed cases, 13 were excised by laparotomy and 13 laparoscopically. 2 were drained under interventional radiology guidance, 1 ruptured spontaneously, and 1 did not report the approach.
  • Of the 2 drained cases, 1 recurred. Of the excised cases, 1 recurred (median follow-up 24 months, range 0 to 60 months).
  • Among the reviewed cases, the most common origin was the ovary (23%, N = 7), followed by the recto-vaginal space (17%, n = 5). In 7 cases (23%) the origin was given broadly as the pelvic cavity.
• The authors' conclusion: The authors concluded that this was the first documented peritoneal inclusion cyst originating from the umbilical cicatrix. They stated that pre-operative imaging matters in patients with atypical hernia features, that existing literature supports surgical excision rather than drainage given the risk of recurrence, and that laparoscopic surgery should be considered.
• Limitations the authors state:
  • The authors acknowledged that the evidence base is limited, especially regarding image-guided drainage (only 2 cases).
  • The authors stated that the requirements for surveillance and follow-up are unknown and need further research.

Topics

Medical terms in this study, explained in our Lexicon: Umbilical Hernia, Systematic Review.

Related studies

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• A Mesothelial Inclusion Cyst Presenting in a 40-Year-Old Woman as Abdominal Pain and Bloating - A Rare Diagnosis — S. Canadas, R. Fernandes, et al. (2020)
• A Rare Case of Multilocular Mesothelial Inclusion Cysts of the Pericardium: Diagnosis, Treatment, Follow Up, with Comprehensive Review of the Literature — A. Shadmanian, K. Patel, et al. (2025)
• Multilocular peritoneal inclusion cyst (multicystic mesothelioma) with hyaline globules — J. Lamovec, J. Sinkovec (1996)
• Peritoneal Inclusion Cyst in a Young Patient With a Long History of Abdominal Surgeries: A Case Report — J.O. AlTamimi, E.A. Alzahrani, et al. (2023)
• Collagenous Spherulosis in Well-Differentiated Papillary Mesothelioma in a Female With Multilocular Peritoneal Inclusion Cysts — B. AbdullGaffar, L.G. Raman (2019)

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