Solitary rectal ulcer syndrome

Vaizey, C. J.; Bogaerde, J. B. Van Den; Emmanuel, Anton; Talbot, Ian C.; Nicholls, R. J.; Kamm, Michael A.

doi:10.1046/j.1365-2168.1998.00935.x

Cited by 110 publications

(78 citation statements)

References 69 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The number of patients who reported mucus in their stool, digital evacuation and excessive straining were higher than those reported earlier. 3 However, blood in stool was similar as described previously. 3 Earlier, it has been suggested that rectal mucosal intussusception is a pathognomonic finding in patients with SRUS.…”

Section: Discussionmentioning

confidence: 58%

“…3 However, blood in stool was similar as described previously. 3 Earlier, it has been suggested that rectal mucosal intussusception is a pathognomonic finding in patients with SRUS. 38,39 In the present study, only 2 (5%) of our patients showed mucosal intussusception and none had rectal prolapse as reported in other studies.…”

Section: Discussionmentioning

confidence: 58%

“…Mucosal ischemia was proposed to be an etiological factor in the past. 3 Recently, fecal evacuation disorder (FED; also known as functional defecation disorder) has been proposed to be an important factor in the pathogenesis of SRU in a few uncontrolled studies on small number of patients. 4 Some studies showed symptomatic benefit, ulcer healing and improvement in mucosal blood flow following biofeedback in patients with SRUS.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

Sharma

Misra

Ghoshal

2014

J Neurogastroenterol Motil

View full text Add to dashboard Cite

Background/Aims Data on frequency of fecal evacuation disorder (FED) among patients with solitary rectal ulcer syndrome (SRUS), hitherto an enigmatic condition, are scanty. Moreover, most such studies had limitations due to small sample size and lack of inclusion of healthy controls (HC). Methods Forty patients with SRUS underwent symptom assessments, sigmoidoscopy, anorectal manometry, defecography, balloon expulsion test (BET); endoscopic ultrasound (EUS) of anal sphincter complex was performed in a subgroup. Physiological tests (anorectal manometry and BET) were also performed in 19 HC. Results Patients with SRUS (26/40 male, age 37 [18–80] years) more often had FED than HC (10/19 male, age 43 [25–72] years) as shown by weight needed to expel the balloon (300 [0–700] g vs. 100 [0–400] g; P = 0.006), a trend towards abnormal BET (need of > 200 g weight for expulsion) (21/40 [53%] vs. 5/19 [26%], P = 0.058) and impaired anal relaxation (14/40 [35%] vs 2/19 [10.5%]; P = 0.048). Using Rome III criteria, most patients with SRUS reported having chronic constipation (36/40 [90%]) in spite of having normal (Bristol stool type IV, 21/40 [53%]) and diarrheal (types V, VI, VII, 6/40 [20%]) stool forms (Asian classification). SRUS patients more often (17/40 [43%]) had functional defecation disorder (Rome III criteria). Patients with SRUS with abnormal BET had thicker internal anal sphincter than those without (3.9 [3.4–7.0] mm vs 2.8 [2.0–4.0] mm; P = 0.01). Conclusions FED was commoner among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal sphincter on EUS than those without.

show abstract

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

Sharma

Misra

Ghoshal

2014

J Neurogastroenterol Motil

View full text Add to dashboard Cite

show abstract

“…Lesions are most commonly on the anterior rectal wall, although they can be extensive or circumferential; and N classical histological appearance of fibrous obliteration of the lamina propria with disorientation of the muscularis mucosa and extension of smooth muscle fibres into the lamina propria [1].…”

Section: Case Reportmentioning

confidence: 99%

“…Ischaemia is considered an important factor in the development of SRUS with small-vessel trauma at the apex of a prolapsing mucosal fold predisposing to ischaemia [1]. The presence of internal or external rectal prolapse and paradoxical contraction of the pelvic floor might be involved in the development of SRUS, with the high rectal pressures needed to produce rectal voiding in the presence of external sphincter contractions predisposing to ischaemia and ulceration of the rectal mucosa [2].…”

Section: Case Reportmentioning

confidence: 99%

Solitary rectal ulcer syndrome mimicking rectal neoplasm on MRI

Amaechi

Papagrigoriadis²,

Hizbullah

et al. 2010

BJR

View full text Add to dashboard Cite

ABSTRACT. Solitary rectal ulcer syndrome (SRUS) is a rare condition that typically affects young adults and describes a spectrum of clinicopathological abnormalities. The diagnosis of SRUS is usually made on the basis of a combination of presenting symptoms and endoscopic and histological appearances. Characteristic radiological appearances have been described on transrectal and endoanal ultrasound, defecating proctography and barium enema. The radiological appearance of solitary rectal ulcer on MRI has not been previously described. MRI appearance of thickened ulcerated mucosa in the anterior rectal wall are non-specific and was indistinguishable from a malignant process. However, given that solitary rectal ulcer has a pre-disposition to occur in the anterior rectal wall, the presence on MRI of thickened rectal mucosa in this location could suggest solitary rectal ulcer in the correct clinical context. Case reportA 48-year-old man presented with a 6 week history of reduced bowel action and weight loss with episodes of rectal bleeding. Abdominal examination was unremarkable. Digital rectal examination identified a possible polypoid lesion approximately 5 cm from the anal margin. Colonoscopy revealed a broad-based lesion with an irregular surface measuring approximately 4 cm in diameter (Figure 1). This lesion was reported as a probable malignant ulcerating polyp; T 1 and T 2 weighted MRI of the rectum was performed for further evaluation.MRI demonstrated an area of focal thickening in the anterior rectal wall with a central area of ulceration confined to the mucosa. The muscularis propria was intact with no enlarged regional lymph nodes or fatty stranding (Figure 2). On the basis of these MRI features and the clinical history, a diagnosis of ulcerating rectal lesion with provisional staging of T1N0 was made. Carcinoembryonic antigen (CEA) levels were within normal limits at ,2.Histological analysis of biopsy specimens taken at the time of colonoscopy revealed features consistent with solitary rectal ulcer syndrome (SRUS): distortion of the crypts, splaying of the smooth muscle fibres of the muscularis mucosa, foci of hyperplasia in the crypts and the presence of muscle fibres and fibroblastic cells in the rectal mucosa; immunohistological staining excluded a neoplasm (Figure 3).On further questioning, the patient reported a history of obstructive defecation with digitation. Defecating proctography was performed. Digital rectal examination before the procedure revealed a fleshy mass at the 12 o'clock position. Rapid rectal evacuation was demonstrated with a significant small bowel enterocele and a degree of external rectal prolapse on defecation. There was no evidence of intussusception (Figure 4).

show abstract