Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly

Objective: To identify endometriosis as a cause of chronic pelvic pain in premenarcheal girls without an obstructive anomaly of the reproductive tract. Design: A case series. Setting: Tertiary-care academic pediatric hospital. Patient(s): Five premenarcheal girls with chronic (>6 months) pelvic pain and negative gastrointestinal workup. Intervention(s): Laparoscopic biopsies and resection, laser and/or cautery of all visible lesions. Main Outcome Measure(s): Visual presence of endometriosis and decrease in pelvic pain after destruction of lesions. Result(s): All subjects had laparoscopy with the identification of clear, red, and/or white lesions consistent with endometriosis based on the standard American Society for Reproductive Medicine Classification of Endometriosis. Postoperatively, all of the girls had marked improvement of their pelvic pain based on self-reported pain scales. Two of the subjects had subsequent repeat laparoscopies 6 and 8 years after their initial surgery, which revealed pathology-proven endometriosis. Conclusion(s): Endometriosis should be part of the differential diagnosis of chronic pelvic/lower abdominal pain in premenarcheal girls. The presence of lesions visibly consistent with endometriosis in premenarcheal girls without an obstructive anomaly supports the concept that some cases of endometriosis may result from an etiology other than retrograde menses.