Solitary rectal ulcer syndrome: A clinicopathological study of 13 cases

Abstract

Background/Aims:Solitary rectal ulcer syndrome (SRUS) is a rare disorder that has a wide spectrum of clinical presentation and variable endoscopic findings. To further characterize the clinical and pathological features, a retrospective, hospital-based clinicopathological study was conducted.Materials and Methods:All cases of SRUS diagnosed at Farwania Hospital, Kuwait, between 2002 and 2007 were retrieved from the computerized filing system. The histological slides were reviewed by two authors to confirm the diagnosis. Immunohistochemical stain for smooth muscle actin (SMA) was performed. The clinical files were reviewed for clinical features and endoscopic findings.Results:Thirteen cases were identified: 8 males and 5 females. The age range was 15–85. Rectal bleeding, constipation, and abdominal pain were the most common presenting symptoms and were seen, either alone or in various combinations, in 12 of the 13 cases. Rectal ulceration was the most common endoscopic finding, being seen in 9 of the 13 cases; 3 of these cases had multiple ulcerations. Two patients had rectal polyps, with one of them having multiple polyps. The histological examination revealed surface serration, fibromuscular obliteration of the lamina propria, and crypts' distortion in all the cases. Seven of the cases had diamond crypts. Ectatic mucosal vessels were a common finding. Positivity for SMA in the lamina propria was seen in all examined cases.Conclusion:SRUS is a rare disorder and only 13 cases were diagnosed in Farwania hospital over a 6-year period. The clinical presentation of our patients was variable. The presence of polyps and multiple ulcerations on endoscopy is further evidence that SRUS is a misnomer. Surface serration, fibromuscular obliteration, and crypts' distortion are the most characteristic features. The presence of diamond crypts is an additional diagnostic feature.

Long Term Conservative Approach in a Young Male with Solitary Rectal Ulcer Syndrome

“…The endoscopic findings can be multiple ulcerations and polyps. The histopathological findings are also variable like surface ulcers, fibromuscular obliteration and crypts distorsion with diamond crypts in a few cases only [12].…”

Pelvic floor disorders: what’s the best test?

“…Endoanal ultrasound (EAUS) is also used in SRUS patients who present with chronic constipation to exclude other causes such as sphincter thinning and defects (Fig. 11) [55].…”

Solitary Rectal Ulcer: A Literature Review

“…Of these, sixty patients were female and 75 were male. Table 1 shows the demographic characteristics of patients in different countries that have been studied in the large centers for treatment of gastrointestinal diseases (8)(9)(10)(11)(12). As the table shows, males have been affected more than females, although the difference is not significant.…”

“…Some of the endoscopic findings in this disease can be completely nonspecific, such as the presence of thickened mucosa (12) and stricture, which can be very similar to cancer (19,(39)(40)(41)(42)(43)(44). The endoscopic findings of SRU can mostly be similar to inflammatory bowel diseases and rectal carcinoma, which necessitate concomitant biopsy for definitive diagnosis (44).…”