Authors: Thomas Kirengo , Samuel Ghattas , Mostafa AbdelKarim , Samra Ali , Mohiuddin Kamal , Joseph Mechery , Ali Murtada

Abstract

Background: Benign ovarian tumours affect around 10–20% of women during their lifetime, with mature ovarian cystic teratomas (MOCTs) comprising about 70% of cases in those younger than 40 years. MOCT fistulation into the bowel is a rare and poorly characterised complication. This systematic review aimed to summarise all reported cases of ovarian teratoma complicated by bowel fistulation, focusing on clinical presentation, diagnostic methods, management strategies, and outcomes.

Method:

A systematic search of PubMed®, SCOPUS, and EMBASE was conducted from inception to October 2025 in accordance with PRISMA guidelines. All case reports describing ovarian teratoma with bowel fistula were included. Data extracted included demographics, clinical features, imaging, management, histopathology, and outcomes.

Results:

Thirty-five cases published between 1965 and 2025 were identified. The mean patient age was 41.5 years (range 9–85 years). Abdominal pain (77.1%) and rectal bleeding (30.3%) were the most frequent presenting symptoms. Computed tomography (CT) was the predominant imaging modality (80%), while endoscopy was performed in 60% of cases. Surgical resection was the standard treatment (97.1%), mainly via open laparotomy, with laparoscopy or robotic surgery in 20%. One patient was successfully managed conservatively. Malignant transformation occurred in 20% of cases, with an overall mortality rate of 11.4%.

Conclusion:

Ovarian teratoma with bowel fistulation is a rare but clinically significant complication. Early cross-sectional imaging facilitates diagnosis, and multidisciplinary input is vital to guide management. Surgery remains the mainstay of treatment, though non-operative management may be feasible in carefully selected benign cases.

Keywords: Mature Ovarian Cystic Teratoma, Dermoid Cyst, Bowel Fistula, Systematic Review