Feysel Hassen Issack,1 Seid Mohammed Hassen,1 Ferid Ousman Mummed,1 Kaleab Habtemichael Gebreselassie,1 Seid Kedir Hassen,2 Ibsa Kedir Hassen1 1Department of Surgery, Urology Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia; 2Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Feysel Hassen Issack, Department of Surgery, Urology Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa,

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... thiopia, Tel +251932511145, Email feyselh@gmail.comBackground: Adnexal teratoma involving the urinary bladder is a very rare condition. Presentation is variable ranging from irritative LUTS (lower urinary tract symptoms) to pilimiction or trichiuria (passage of hair in the urine).Case Presentation: We report a case of a 42-year-old woman who presented with pilimiction and lower abdominal pain. Contrast-enhanced computed tomography scan (CECT) and cystoscopy were used for the diagnosis. Tumor markers were negative. Right side salpingo-oophorectomy and partial bladder wall excision were performed. Histopathology of the specimen showed features consistent with mature teratoma. The patient reported improvement of symptoms in the subsequent follow-up visits.Conclusion: Pilimiction is a pathognomonic sign of bladder teratomas. This case represents a rare complication of ovarian teratoma. Therefore, a high index of suspicion is required in patients with ovarian teratoma presenting with urinary complaints. Transurethral resection is associated with a high recurrence rate and is not recommended for secondary bladder teratomas.Keywords: pilimiction, adnexal mass, bladder teratoma, trichiuria, case report