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

Robert Peterek^1*Karolina Kowalczyk²Aleksandra Leziak¹Rafał Stojko²Agnieszka Drosdzol-Cop²

• ¹Department of Gynecological Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
• ²Chair and Clinical Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, Katowice, Poland

Objective: 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. Methods: 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: endometriosis, adolescents, laparoscopy, atypical presentation, bowel lesions, hydrosalpinx, coexisting ovarian tumor, pelvic organs shift. Inclusion criteria were: adolescent age of patients (age 10-19), laparoscopic confirmation of endometriosis diagnosis. We excluded articles published in languages other than English. Results: Young patients present atypical, nonspecific 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. Conclusions: In adolescents, diagnosis of endometriosis remains challenging because of nonclassical clinical manifestations and atypical laparoscopic findings compared to 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 for pediatricians, who are often the first medical contact for these patients.