Benign multicystic peritoneal mesothelioma (BMPM) is a rare disease that primarily affects fertile women with previous abdominal surgery. BMPM associated with adenomatous tumor is a single case report, according to our opinion. The patient had a history of abdominal surgery nine years ago for ovarian cysts. Upon admission, the diagnosis was acute surgical abdomen with acute peritonitis signs. The treatment applied consisted in the removal of peritoneal cysts and partial omentectomy. Only immunohistochemical examination established the diagnosis. The aim is to discuss diagnostic and therapeutic difficulties, underlining that there is no consensus on the use of chemotherapeutics. In conclusion, establishing a preoperative diagnosis is difficult if not impossible. One of the causes of acute surgical abdomen may be BMPM. The malignant transformation of this disease is rare, but the disease recurrence rate is over 50%, and it is often recommended to be monitored through abdominal computed tomography.