Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Endometriosis is a common cause of abdominal pain in young adults.
The overall incidence of endometriosis in adolescent females appears to be low based on diagnosis by pediatric surgeons.
Pediatric surgeons are often the surgical gynecologists for many patients and frequently perform diagnostic laparoscopies for abdominal pain.
Young patients who present to gynecology with chronic abdominal pain often saw 3 physicians prior to laparoscopy for confirmation of endometriosis, leading to a 23 month delay in treatment.
In adolescence, endometriosis is more likely to appear as red and clear lesions.
Evaluation should begin in the anterior cul-de-sac, the area above the bladder and anterior to the uterus.
Red lesions with adhesions, dark lesions, red lesions, and white lesions along the bladder flap can be seen in the anterior cul-de-sac.
Bilateral round ligaments should be evaluated as they insert into the inguinal canal.
The appendix should be examined for endometriotic lesions, which may appear as multiple red lesions or a single red lesion at the tip.
The bowel should be run with particular attention to the cecum and sigmoid colon, as they are often involved.
The upper abdomen and diaphragm should be evaluated, including visualization of the liver, gallbladder, and stomach.
Multiple white and dark lesions can be seen along the right hemi diaphragm in diaphragmatic endometriosis.
Diaphragmatic endometriosis can become quite extensive with miliary distribution of lesions.
The presacral space should be examined, looking from the aortic bifurcation cranially, the sacral promontory caudally, and common iliac vessels bilaterally.
With lateral retraction of the ovary, multiple dark lesions can be demonstrated, with care taken to examine all surfaces of the ovary.
Gentle manipulation of the fallopian tube may show dark lesions in the ampullary portion that can appear to partially obstruct indigo carmine dye extravasation.
Hemosiderin deposits can look similar to red lesions, but wash away with suction and irrigation.
To evaluate depth of lesions, vaginal exam, rectal exam, and sigmoidoscopy are key adjuncts.
Consideration of endometriosis should be included in all laparoscopies for abdominal pain in the adolescent female.
Evaluation should be routine and systematic.
The pelvic side wall should be examined with gentle medial retraction of the ovary to visualize lesions over the ureter.
White, red and clear lesions can be seen along the pelvic wall.
Medial rotation of the rectosigmoid allows for evaluation of the right paracolic gutter.
The posterior cul-de-sac may show a miliary pattern of fibrosis or isolated red and white lesions along the rectum.
Peritoneal defects should be evaluated as they may hide endometriotic lesions.