Rectal fistula due to ovarian teratoma.

We present a rare case of ovarian teratoma involving both the rectum and the urinary bladder. A 23-year-old woman presented with lower abdominal pain for 5 years, passing hairs in her stools for 18 months, and passing hairs in her urine and increased frequency of micturition for 4 months. On clinical examination, no mass was palpable. Abdominal ultrasound revealed a left adnexal echogenic lesion involving the urinary bladder. Examination of the urine revealed pus cells. A computed tomography (CT) scan of the abdomen showed a 4.0×5.6×4.2-cm, illdefined mass with specks of calcification that was protruding into the bladder cavity through its left posterior wall (●" Fig.1). The mass also had air specks within it and was adherent to the rectosigmoid colon, as shown by loss of the fat plane. Colonoscopy showed a growth that had a tuft of hair protruding into the lumen at 15cm from the anal verge (●" Fig.2). Intraoperative findings included a 5×4× 3.5-cm left ovarian mass that was invading the urinary bladder anteriorly and the rectosigmoid colon posteriorly. A left ovarian teratoma was excised (●" Fig.3). The defects in the urinary bladder and colon were closed primarily. Histopathology of the resected specimen revealed a mature ovarian teratoma. The patient has been followed up regularly for the last 6 months. Complications of ovarian dermoids include torsion (16%), rupture (1%–4%), malignant transformation (1%–2%), infection (1%), and invasion into adjacent viscera (<1%) [1]. The bladder and rectum are the organs most commonly involved when spontaneous rupture into adjacent viscera occurs [2–4]. Patients with rupture of a dermoid cyst into the bladder may present with complaints such as pilimiction (passage of hair in the urine) or passage of other material from the dermoid cyst [5]. The formation of fistulas with the urinary bladder and the rectum in the same patient is a very rare complication of ovarian dermoid cysts. To the best of our knowledge, such a case has not been previously reported. Endoscopy_UCTN_Code_CCL_1AD_2AG