No abstract

A 41−year−old woman (gravida 2, para 2) was admitted to hospital with intermit− tent abdominal pain which she experi− enced during defecation. Her medical his− tory was uneventful. Colonoscopy re− vealed a hyperemic, polypoid mass with a stalk, 15 cm from the anal verge ( Fig− ure 1); computed tomography revealed a right ovarian mass that was continuous with the intraluminal lesion in the sig− moid colon. At surgery, a right ovarian mass was identified which was adhering to the sigmoid colon and to the pelvic peritoneum on the right side. Right sal− pingo−oophorectomy and an anterior re− section with a colorectal anastomosis were performed. The resected specimen included a pedunculated polyp of the sig− moid colon, which was continuous with an ovarian mass (Figure 2). The length of the polyp stalk was 1.8 cm. The pathologi− cal diagnosis was a benign mature cystic teratoma which had ruptured, leading to the formation of a colonic fistula, and which had subsequently protruded into the colonic lumen. The patient had no postoperative complications and was dis− charged from hospital 8 days after the op− eration.The complications of ovarian teratoma in− clude torsion, rupture, infection, and ma− lignant change [1]. The rupture of an ovar− ian teratoma into an adjacent hollow vis− cus is a rare complication. Previously re− ported endoscopic examinations of tera− tomas that have ruptured into the adja− cent colon have revealed the presence of hair or teeth in the mass and polypoid masses extending into the rectum [2]. In the present case a right ovarian teratoma had ruptured into the colon and appeared as a pedunculated polyp on colonoscopy examination. It is important to distin− guish between primary rectal teratomas and protruding ovarian teratomas. The majority of primary rectal teratomas fea− ture pedunculated polyps protruding into the rectal lumen which have arisen as a result of the peristaltic movement of the bowel [3], and can be removed endoscop− ically [4]. A pedunculated polyp extend− ing into the rectum from an ovarian tera− toma is an extremely rare occurrence and one which requires surgical treatment.