Ovarian Teratoma with Bowel Fistula managed non-operatively

<p><strong>Background: </strong>Mature ovarian cystic teratomas (MOCT) are the most common benign ovarian tumours. They are mainly asymptomatic (60%) but can in rare cases (<1%) complicate by forming a fistula into adjacent structures such as the bowel. Patients with fistulating ovarian teratomas are typically managed surgically, most often requiring laparotomy.</p> <p> </p> <p><strong>Case Presentation: </strong>We report a case of an 18-year-old woman who presented with vague abdominal and gynaecological symptoms. She expelled a mass with hair and teeth per rectum which was later confirmed as a MOCT.  We managed her conservatively as a collaboration with colorectal and gynaecology teams. At one-year follow-up, she remained asymptomatic with no radiological evidence of a residual fistula.</p> <p> </p> <p><strong>Conclusion: </strong>This case highlights the diagnostic challenges in MOCT with a bowel fistula. We demonstrate that conservative management may be a viable option in select patients.</p>