Uterovaginal prolapse is a common disease with age dependent increase in incidence [1]. Thus, in a previous report [2] on 78 women in our developing community, the general run of the cases recorded in a 30-year period was to the effect that the youngest was aged 20 years, while 69 patients or 88.5% clustered between 40 and 69 years of age.

Age of early onset of a disease is necessarily of epidemiologic interest. Elsewhere, as regards uterine procidentia, it was put at 17 years in Nigeria [3]. Therefore, our case of a younger age is deemed worthy of publication.

A 15-year-old girl in Nigeria had her menarche at 14 years of age. She had menstruated thrice before presenting at a Missionary Hospital with 30 prolapse of the uterus. She had never been pregnant. However, there was a past history of bilateral inguinal hernia operation at another hospital the year before. At laparotomy, a large sized ovarian cyst was found to occupy almost the entire pelvis. Ovarian cystectomy was performed as well as Gilliam’s suspension of the uterus by one of us (DT). The operations were undertaken with a mature relation’s consent. The removed ovary measured 12 cm across (Figure 1).

Figure 1: Excised specimen of the ovarian teratoma.

On section, it was multiloculated and contained straw coloured fluid. In one area, the solid part contained straight black hairs, greasy matter and bone. Microscopical confirmation of the presence of the three layers characteristic of benign teratoma completed the pathological observations by one of us (WO). Recovery was uneventful.

Uniqueness in presentation is of epidemiological interest in terms of a histopathologic data pool [4]. Thus, we found, on checking our Reference Pathology Laboratory records, that teenagers presenting with abdominal masses, which resulted from ovarian teratomas, numbered 23 cases. It was only in the present patient that uterovaginal procidentia occurred. The local age pattern also strengthened the present case’s uniqueness. Thus, Table 1 shows that clustering was towards the eldest group rather than the youngest.

Table 1: Age pattern of ovarian teratoma in Nigerian teenagers.

A report from France [5], concerning prolapse in the young woman, revealed association with operations for abdominal hernias. Our case qualifies for this etiologic agent. This is bolstered by the size which was not the heaviest, seeing that its recorded 12 cm width was actually the average while the range was from 6 cm to 30 cm.

Candy [6] found in 1976 that uterine suspension had become an infrequent operation on most gynecologic services but that the round ligament fixation to the rectus sheath described by Gilliam was commonly employed because of its ease, effectiveness, and low complication rate. This has been our experience in this hinterland Missionary Hospital. Undoubtedly, the recent review by Lin’s associates [7] noted that the most appropriate surgical approach for uterine preservation still remains the subject of ongoing controversy. They found that there is a paucity of research studies and publications in this field and favored sacral colpohysteropexy.

Ovarian pathology, as far as the teratoma is concerned, is of considerable diversity [8]. Therefore, it is important to document any unusual parameters occurring in pediatric and adolescent patients, especially from developing countries. However, at the hinterland Mater Hospital, where this patient was treated, ultrasound pelvic CT scan was not available.