# Uncommon diagnostic aspects of adolescent endometriosis: case series with narrative review of the literature

## TL;DR

This paper discusses unusual ways endometriosis can appear in teenagers, using four case studies and a literature review to highlight diagnostic challenges.

## Contribution

The study contributes four adolescent endometriosis cases with atypical symptoms and laparoscopic findings, emphasizing the need for increased awareness in diagnosis.

## Key findings

- Adolescent endometriosis can present with non-specific symptoms and atypical laparoscopic features.
- Common atypical findings include bowel lesions and pelvic structural distortion due to uterosacral ligament shortening.
- Successful treatment was observed with oral contraceptives and laparoscopic intervention despite moderate-stage disease.

## Abstract

Endometriosis is a gynecological disorder for which awareness and detection rates are rising globally. The purpose of this study is to highlight atypical presentations of the disease; to present four adolescent patients with laparoscopically confirmed endometriosis at our hospital in Katowice, Poland, in 2024; and to discuss these cases in the context of the relevant literature.

We present the clinicopathological data of four adolescent patients with atypical presentations of endometriosis who were treated at our institution with a comprehensive report of laparoscopic examination. We performed a narrative PubMed review for the period 2017–2025 to identify and discuss atypical clinical symptoms and laparoscopic findings of adolescent endometriosis. We used the following keywords were used: endometriosis, adolescents, laparoscopy, atypical presentation, bowel lesions, hydrosalpinx, coexisting ovarian tumor, pelvic organs shift. Inclusion criteria were adolescent age of patients (age 10–19) and laparoscopic confirmation of endometriosis diagnosis. We excluded articles published in languages other than English.

Young patients present atypical, non-specific clinical symptoms and diverse laparoscopic appearances. Shared features included lesions on the serous membrane of the large bowel and pelvic structural distortion as a consequence of uterosacral ligaments shortening or uterine adherence to the anterior abdominal wall. Additional findings included hydrosalpinx and the coexistence of an ovarian tumor. The follow-up confirmed the therapeutic success as a consequence of compliance with the oral contraceptive regimen and the following laparoscopic approach, despite the moderate-stage endometriosis in the majority of the reported cases.

In adolescents, the diagnosis of endometriosis remains challenging because of non-classical clinical manifestations and atypical laparoscopic findings compared with those observed in adults. The presented atypical cases underscore the importance of careful interview and consideration of rare anatomical anomalies that may co-occur with endometriosis. Increasing awareness of the disease's diverse clinical variants is important among adolescent patients, their parents, and especially pediatricians, who are often the first medical contact for these patients.