A Clinical Entity Often Missed—Solitary Rectal Ulcer Syndrome in Children

Abstract

Background: Solitary Rectal Ulcer Syndrome (SRUS) was a relatively uncommon and easily misdiagnosed clinical entity in children. The diagnosis of this condition was often delayed due to lack of clinical suspicion. Only case series were available and no definitive treatment was postulated. Here, we share our experience of SRUS in our institute and reviewed the literature published so far. Aim: To study the clinical profile and treatment response of Solitary Rectal ulcer Syndrome in Children (SRUS). Materials: The clinical profile and 1 year follow up response of the diagnosed cases of SRUS over a period of 5 years was retrospectively collected from medical record department. Results: The median age of presentation among 24 children was 8 years with majority (75%) above 5 years. All children presented with intermittent rectal bleeding with median duration of 5.5 months. The other presenting symptoms documented were hard stool (79%), mucorrhea (70%), and abdominal pain (58%). One child presented with rectal prolapse. On colonoscopy, 46% had single ulcer while another 46% had multiple ulcers and 8% had polypoidal lesion. All lesions were within distal rectum and had characteristic histological pattern. All children were treated with conventional treatment like dietary fibers and laxatives along with toilet training. About 75% children attained remission and 25% had relapse but responded with corticosteroid enema. None required surgery. Conclusion: Conventional treatments itself induce and maintain remission in most of SRUS patients if treatment is instituted at the earliest. Thus, early suspicion and diagnosis is needed to achieve remission.

Solitary rectal ulcer syndrome: Role of hydrocortisone enema in pediatric patients.

“…Experts advise steroid enemas to be useful as was found in this study along with conventional treatment options for SRUS. [23][24][25] The present study is the 1 st local research analyzing effectiveness of hydrocortisone enemas along with conventional therapy versus conventional therapy alone for the treatment of SRUS which makes the findings of the present study very interesting. Our study had some limitations.…”

Tenesmo: consigli pratici di gestione nei pazienti eleggibili alle cure palliative pediatriche

“…In ambito oncologico pediatrico il tenesmo può associarsi a patologie oncologiche a carico del retto-sigma, della regione pelvica, dell'apparato urogenitale, linfomi e metastasi o in pazienti che siano stati sottoposti a radioterapia della regione pelvica. Tuttavia, il tenesmo in età pediatrica e adulta non è da limitare al solo ambito oncologico ma può essere osservato anche in pazienti con: y stipsi ostinata, fecalomi, prolasso rettale; y storia di fissurazioni, ulcere anorettali, polipi rettali, emorroidi, adenomi; y malattie infiammatorie croniche; y solitary rectal ulcer syndrome [3]; y infezioni intestinali (schistosomiasi, Shighella, Campilobacter, Clostridium difficile), proctite o ascessi; y appendicite pelvica; y presenza di corpo estraneo.…”

“…Per quanto concerne invece il trattamento del tenesmo e del dolore anorettale, va fatta un'ulteriore differenziazione tra strategie farmacologiche e non farmacologiche. Le strategie farmacologiche riportate in letteratura sono: y Steroidi e antinfiammatori: anche l'uso di steroidi per via sistemica (desametasone) o per via rettale (clisteri di corticosteroidi), così come quello di farmaci antinfiammatori quali sulfasalazina eLe strategie non farmacologiche sono: y simpatectomia lombare[1][2]; y blocchi del plesso ipogastrico superiore[1][2]; y interventi endoscopici di laser (ELT)[2][3][4][5][6][7][8][9][10][11]; y chirurgia eviscerativa solo in casi eccezionali.…”

Argon plasma coagulation: an effective treatment for solitary rectal ulcer syndrome

“…Hence, they are categorized as SRUS resistant to conventional treatment. 9 There are other treatment options available for patients who do not respond to both conventional and endoscopic treatment. 10 …”