title: Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly.
abstract: OBJECTIVE
  To identify endometriosis as a cause of chronic pelvic pain in premenarcheal girls without an obstructive anomaly of the reproductive tract.
  
  
  METHODS
  A case series.
  
  
  METHODS
  Tertiary-care academic pediatric hospital.
  
  
  METHODS
  Five premenarcheal girls with chronic (>6 months) pelvic pain and negative gastrointestinal workup.
  
  
  METHODS
  Laparoscopic biopsies and resection, laser and/or cautery of all visible lesions.
  
  
  METHODS
  Visual presence of endometriosis and decrease in pelvic pain after destruction of lesions.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gynecology, Department of Surgery, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
authors.forename: Erica E
authors.initials: EE
authors.lastname: Marsh
authors.forename: Marc R
authors.initials: MR
authors.lastname: Laufer
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002908:Chronic Disease; D004715:Endometriosis / Q000473:pathology*; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D008572:Menarche; D017699:Pelvic Pain / Q000473:pathology*