Clinical and manometric features of the solitary rectal ulcer syndrome

Abstract

We report 33 patients with the solitary rectal ulcer syndrome seen between 1975 and 1982. Twenty-four were women and the median age was 32 years. The principal symptoms were bleeding (89 per cent), chronic constipation (64 per cent), rectal pain (42 per cent), tenesmus (42 per cent), and mucous discharge (45 per cent). Twenty-eight patients gave a history of straining (85 per cent). A full-thickness rectal prolapse was present in six patients, an anterior rectal prolapse was observed in 11, and 12 patients had clinical evidence of perineal descent. Defecation was only possible by digital evaluation in six women, and three male patients were passive homosexuals. Manometric studies were performed on 16 patients; eight patients were unable to tolerate rectal distention with 200 cc of air and impaired rectal sensation was present in two. Rectal distention was associated with bursts of involuntary external sphincter activity in three patients, and the distention reflex was absent in six, despite normal ganglia on rectal biopsy. In only four patients was there electromyographic evidence of contraction of the puborectalis during attempted defecation. Fourteen patients were treated by rectopexy; healing of the ulcer occurred in five of six with a full-thickness prolapse compared with only two of eight without a complete prolapse.

A Rare and Often Unrecognized Cause of Hematochezia and Tenesmus in Childhood: Solitary Rectal Ulcer Syndrome

“…In addition, rectal lesion may be multiple or circumferential and usually occurs on the anterior or anterolateral wall of the rectum, which is not a consistent feature of SRUS. 9,11,14,17 The ulcerated lesion was located on the anterior wall of the rectum in the first case, whereas it was circumferential in our second case. The rest of the colonoscopic examination was completely normal in both cases, which was also confirmed histopathologically by examining the biopsies taken from normal-appearing segments of the entire colon.…”

“…9,11,14 In contrast, in patients with mucosal or full-thickness rectal prolapse with severe symptoms, rectopexy (Ekehorn sacrorectopexy, Ripstein sling, or retrorectal fixation) results in symptomatic relief in approximately 40% to 60% of patients. 17,[21][22][23] However, it is not possible to draw a conclusion from these studies for treatment of pediatric patients with SRUS. Both of the patients presented here experienced intermittent rectal prolapse, and both of them completed 1-year conservative treatment.…”

“…[1][2][3] Histologically, the presence of fibromuscular obliteration of the lamina propria with disorientation of muscle fibers is characteristic, which could be secondary to chronic mechanical and ischemic trauma and inflammation by hard stools, and intussusception of the rectal mucosa. 2,3,[12][13][14][15][16][17] Although the syndrome is well-recognized in adults, the pediatric experience with this condition is limited and often remains unrecognized or misdiagnosed. [1][2][3][4][5][6]13,14 A misdiagnosis has been reported in one fourth of adult cases, and the correct diagnosis usually delayed approximately 5 to 7 years.…”

Outlet Syndrome: Is There a Surgical Option?

“…Sometimes the phenomenon is associated with slow transit constipation (Cummings et al 1976) or with the solitary rectal ulcer syndrome (Keighley & Shouler 1984). The features of this abnormality are failure to pass a balloon containing 150 cm3 of liquid from the rectum and exaggerated electrical activity observed from electromyographic recordings of the puborectalis.…”

5-ASA Therapy in Solitary Rectal Ulcer Syndrome. Report of Three Patients

“…In some patients, abnormal pelvic fl oor relaxation has also been detected (6,LL,12,(14)(15)(16)(17)(18).…”