title: Adolescent Endometriosis: Report of a Series of 55 Cases With a Focus on Clinical Presentation and Long-Term Issues.
abstract: OBJECTIVE
  To report the clinical presentation and long-term issues of adolescent endometriosis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Single private clinical center, Bordeaux, France.
  
  
  METHODS
  Adolescents with a confirmed diagnosis of endometriosis.
  
  
  METHODS
  Surgical excision or ablation or lesions performed at laparoscopy.
  
  
  RESULTS
  Fifty-five adolescents, ages from 12 to 19 years (mean age 17.8), who were diagnosed with endometriosis from March 1998 to April 2013 were included in the study. Pain of various types was the leading symptom in all patients, except 2. Twenty-three patients had an adnexal mass identified preoperatively, and 5 had an associated infertility issue at the time of diagnostic laparoscopy. Four patients had an associated genital malformation. Fifty-one percent of the patients had a history of appendectomy. A familial history of endometriosis was reported by 19 patients (34.5%), with a first-degree relative affected in 14 cases (25.45%), and 47.3% of patients were smoking at least 5 cigarettes a day. Superficial implants was encountered in 31 cases (56.4%), endometriomas in 18 cases (32.72%), and deep infiltrating endometriosis (DIE) in 6 cases (10.90%). Sixty percent of patients were scored as stages I to II and 40% as stages III to IV. Five patients were lost to follow-up, and 37 had a follow-up ranging from 36 to 315 months (mean follow-up 125.5 months). Among the 50 patients not lost to follow-up, 13 (26%) had either no pain, or improved and had acceptable pain with medical treatment. Seventeen patients of the 50 adolescents not lost to follow-up (34%) underwent a repeat laparoscopy. A subsequent laparoscopic and/or magnetic resonance imaging scan was performed in 35 patients because of persistent pain. Among these, there was 12 endometriomas (7 recurrences) and 12 DIEs (3 recurrences), giving recurrence rates for endometriomas and DIEs of 36.84% and 50%, respectively. During the study, 18 patients wished to have a child. Thirteen had a delivery (72.2%), and 9 pregnancies occurred in patients who initially presented with stage I to II endometriosis. Of the 11 patients who had subfertility, 6 successfully conceived (54.5%).
  
  
  CONCLUSIONS
  Adolescent endometriosis is not a rare condition. In our study a familial history was reported in more than one-third of patients. Among those patients treated for DIE, there was a trend for higher rates of recurrences (symptoms or lesions) that required repeat laparoscopy. However, the impact on subsequent fertility appeared to have been limited.
authors: Private practice, Bordeaux, France.
authors: Alain
authors: A
authors: Audebert
authors: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France. Electronic address: liselecointre@hotmail.fr.
authors: Lise
authors: L
authors: Lecointre
authors: IRCAD, Strasbourg, France.
authors: Karolina
authors: K
authors: Afors
authors: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors: Antoine
authors: A
authors: Koch
authors: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors: Arnaud
authors: A
authors: Wattiez
authors: Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.
authors: Cherif
authors: C
authors: Akladios
mesh_terms: D000293:Adolescent; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005602:France / Q000453:epidemiology; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology* / Q000517:prevention & control; D010535:Laparoscopy; D017699:Pelvic Pain / Q000209:etiology / Q000601:surgery; D011331:Private Practice; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Adolescent; DIE; Endometrioma; Endometriosis clinical presentation; Familial history long-term results