Adrenal cysts are rare clinical entities that can present as acute abdomen through rupture and internal hemorrhage as well as chronic symptoms such as gastrointestinal disturbances. A 20-year-old girl presented to our hospital with a 4-years history of abdominal pain and diarrhea. Ultrasound of the abdomen revealed a cystic area measuring 10 x 10 cm between the spleen and left kidney. Computed tomography scan showed a large cystic, homogeneous mass measuring 12.8 x 9.5 x 9.4 cm in the left hypochondrium with most likely origin from the left adrenal gland. Limited work up for hormone hypersecretion was negative. The patient was then encountered in the emergency room with an acute abdomen secondary to intracystic hemorrhage. A laparotomy with left adrenalectomy was performed. Final pathology showed a benign adrenal endothelial cyst. Post-operatively, the patient's long standing complaints of diarrhea and abdominal pain completely resolved. Surgical resection appears a safe and reasonable management strategy in a patient with intracystic hemorrhage of adrenal cyst.