Peritoneal inclusion cyst following total laparoscopic hysterectomy and bilateral salpingo-oophorectomy in a transgender man

Abstract Peritoneal inclusion cysts (PICs) are benign cystic lesions typically observed in women of reproductive age with prior pelvic surgery, endometriosis, or pelvic inflammatory disease. To date, no cases of PICs have been reported in transgender men in South Korea. We present the case of a 28-year-old transgender man who developed a large PIC 1.5 years after undergoing total laparoscopic hysterectomy and bilateral salpingo-oophorectomy as part of gender-affirming surgery. Ultrasound images revealed a progressively enlarging pelvic cyst, and magnetic resonance imaging findings suggested possible connection to bladder. Laparoscopic exploration identified a large, serous, fluid-filled cyst with adhesions, which was successfully excised. Histopathological examination confirmed PIC. The postoperative course was uneventful, with complete symptom resolution and no recurrence at six months. This case underscores the importance of including PIC in the differential diagnosis of pelvic masses in transgender men with a history of pelvic surgery and highlights the need for inclusive, gender-affirming care.