Abstract
BackgroundSolitary rectal ulcer syndrome (SRUS) is an uncommon although benign defecation disorder. The aim of this study was to evaluate the variable endoscopic manifestations of SRUS and its association with other diseases.MethodsAll the patients diagnosed with SRUS histologically from January 1990 to February 2011 at The Aga Khan University, Karachi were included in the study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic and histological findings.ResultsA total of 116 patients were evaluated. The mean age was 37.4 ± 16.6 (range: 13–80) years, 61 (53%) of the patients were male. Bleeding per rectum was present in 82%, abdominal pain in 49%, constipation in 23% and diarrhea in 22%. Endoscopically, solitary and multiple lesions were present in 79 (68%) and 33 (28%) patients respectively; ulcerative lesions in 90 (78%), polypoidal in 29 (25%), erythematous patches in 3 (2.5%) and petechial spots in one patient. Associated underlying conditions were hemorrhoids in 7 (6%), hyperplastic polyps in 4 (3.5%), adenomatous polyps in 2(2%), history of ulcerative colitis in 3 (2.5%) while adenocarcinoma of colon was observed in two patients. One patient had previous surgery for colonic carcinoma.ConclusionSRUS may manifest on endoscopy as multiple ulcers, polypoidal growth and erythematous patches and has shown to share clinicopathological features with rectal prolapse, proctitis cystica profunda (PCP) and inflammatory cloacogenic polyp; therefore collectively grouped as mucosal prolapse syndrome. This may be associated with underlying conditions such as polyps, ulcerative colitis, hemorrhoids and malignancy. High index of suspicion is required to diagnose potentially serious disease by repeated endoscopies with biopsies to look for potentially serious underlying conditions associated with SRUS.
Highlights
Solitary rectal ulcer syndrome (SRUS) is an uncommon benign defecation disorder
SRUS commonly manifests as bleeding or mucoid discharge per rectum associated with abdominal pain, straining, rectal prolapse and sensation of incomplete evacuation [2,6,7]
The most common symptom was bleeding per rectum affecting 95 (82%) patients followed by abdominal pain (49%), constipation (23%), diarrhea (22%) and mucus per rectum (17%)
Summary
Solitary rectal ulcer syndrome (SRUS) is an uncommon benign defecation disorder. Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disorder of defecation, the mechanism of which is poorly understood. Most accepted etiopathogenetic mechanism of SRUS is chronic mucosal and hypoperfusion induced ischemic injury to the rectal mucosa. This is associated with paradoxical contraction of the pelvic floor leading to mucosal prolapse and pressure necrosis of rectal mucosa [1,2]. Endoscopic findings insinuate that the term ‘SRUS’ is a misnomer since neither are the lesions always solitary nor are they always ulcerative They can affect regions other than the rectum [6,7,8]. SRUS is known for its chronic course and a definitive guideline for management remains disputed
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