Adolescent bladder endometriosis initially diagnosed as premenarchal disease: a case report and review of the literature

Akiko Fujishiro, Hiroshi Tsubamoto, Y. Higuchi, Akihiro Kanematsu, Hiroaki Shibahara
In: Clinical and Experimental Obstetrics & Gynecology · 2018 · vol. 45(3) , pp. 446–449 · doi:10.12891/ceog3894.2018 · W3032689490
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-13 ⓘ

This case report details an 11-year-old girl initially diagnosed with premenarcheal endometriosis presenting with bladder endometriosis causing macrohematuria, highlighting the importance of considering this diagnosis in adolescent macrohematuria before menarche.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This case report and literature review examines rare premenarchal endometriosis, focusing on bladder endometriosis, which represents about 1% of all endometriosis cases. The authors describe an 11-year-old girl with macrohematuria due to bladder endometriosis who had no apparent menarcheal vaginal discharge; MRI showed a lesion penetrating bladder musculature and infiltrating the anterior wall of the lower uterine segment, and transurethral biopsy confirmed bladder endometriosis. After three months, she re-presented with recurrent macrohematuria, and periodic episodes were associated with drops in basal body temperature; transrectal ultrasound demonstrated a fistula between the bladder and the internal cervical os. As a single-patient report, the study’s main limitation is its lack of generalizable evidence beyond the described case, but it highlights a diagnostic caveat for adolescent macrohematuria. This paper is centrally about endometriosis—specifically adolescent bladder endometriosis presenting before menarche without typical vaginal discharge.

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Abstract

Only a few cases of premenarcheal endometriosis have been reported in the literature, and bladder endometriosis accounts for 1% of all cases of endometriosis. The authors report the case of an 11-year-old girl who presented with macrohematuria due to bladder endometriosis without apparent menarchal discharge from vagina, and was initially diagnosed as premenarcheal endometriosis. MRI revealed that the lesion penetrated the bladder musculature and infiltrated the anterior wall of the lower uterine segment. She underwent transurethral biopsy and hemostasis, which revealed bladder endometriosis. After three months, she again presented with macrohematuria without exacerbation of bladder endometriosis. Periodic macrohematuria occurred after her basal body temperature dropped. Transrectal ultrasound revealed a fistula in the bladder and the internal cervical os. This is the first report of bladder endometriosis without menarchal discharge, which should be kept in mind when considering differential diagnosis of adolescent macrohematuria without apparent menarche.
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Abstract

Only a few cases of premenarcheal endometriosis have been reported in the literature, and bladder endometriosis accounts for 1% of all cases of endometriosis. The authors report the case of an 11-year-old girl who presented with macrohematuria due to bladder endometriosis without apparent menarchal discharge from vagina, and was initially diagnosed as premenarcheal endometriosis. MRI revealed that the lesion penetrated the bladder musculature and infiltrated the anterior wall of the lower uterine segment. She underwent transurethral biopsy and hemostasis, which revealed bladder endometriosis. After three months, she again presented with macrohematuria without exacerbation of bladder endometriosis. Periodic macrohematuria occurred after her basal body temperature dropped. Transrectal ultrasound revealed a fistula in the bladder and the internal cervical os. This is the first report of bladder endometriosis without menarchal discharge, which should be kept in mind when considering differential diagnosis of adolescent macrohematuria without apparent menarche.

Keywords

- Endometriosis - Bladder - Premenarche - Adolecent

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endometriosisbladder_endometriosis

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