Pathophysiology and Management of Solitary Ulcer Syndrome of the Rectum

Abstract

Solitary ulcer syndrome of the rectum, solitary ulcer of the rectum, mucosal prolapse syndrome and colitis cystica profunda belong to the same disease category with typical clinical manifestations of blood/mucus discharge and abnormal bowel habit. The lesions are either ulcerated or polypoid, mostly present in the anterior rectal wall and often multiple. Overt or occult full-thickness rectal prolapse or partial mucosal prolapse is found to be underlying pathogenic mechanism and perineal descent is also a common feature. Abnormal bowel habit does exist in these patients characterized by straining at defecation. Fibromuscular obliteration of the lamina propriae is a diagnostic feature which makes differential diagnosis from carcinoma or adenoma easy. Conservaive treatment by normalizing bowel habit with laxatives and high roughage diet is usually satisfactory in most cases, but local excision of large polypoid/ulcerated lesion together with surgical procedure for overt rectal/mucosal prolapse, if present, is required when conservative treatment is unsatisfactory.