Solitary rectal ulcer syndrome in association with ulcerative colitis: A case report

Arhan, Mehmet; Önal, İbrahi̇m Koral; Özın, Yasemin; Yeşil, Yusuf; Temuçin, Tülay; Özdemir, Mustafa; Ülker, Aysel

doi:10.1002/ibd.20971

Cited by 5 publications

(7 citation statements)

References 7 publications

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“…Development of SRUS in patients with past history of ulcerative colitis can lead to confusion whether the patient’s symptoms are due to an exacerbation of the primary disease or because of SRUS. In another study, seven patients of SRUS were at first misdiagnosed for IBD [3] while cases of SRUS in patients with history of ulcerative colitis have also been reported [21,22]. However, fibromuscular obliteration and excess mucosal collagen helps in differentiating SRUS from IBD on morphological analysis [23].…”

Section: Discussionmentioning

confidence: 99%

The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases

et al. 2012

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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.

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Section: Discussionmentioning

confidence: 99%

The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases

et al. 2012

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“…Previous case reports in the adult literature have also noted concurrent SRUS and IBD, particularly ulcerative colitis (UC) 15,16 . Thus, a diagnosis of IBD should not preclude consideration of SRUS, as management may differ.…”

Section: Discussionmentioning

confidence: 99%

Solitary Rectal Ulcer Syndrome in Children and Adolescents

Perito

Mileti²,

Dalal³

et al. 2012

J. pediatr. gastroenterol. nutr.

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Objectives To describe the presenting symptoms, endoscopic and histologic findings, and clinical courses of pediatric patients diagnosed with solitary rectal ulcer syndrome (SRUS). Methods We describe 15 cases of SRUS diagnosed at our institution over a 13-year period. Cases were identified by review of a pathology database and chart review and confirmed by review of biopsies. Data were collected by retrospective chart review. Results Presenting symptoms were consistent but non-specific, most commonly including blood in stools, diarrhea alternating with constipation, and abdominal/perianal pain. Fourteen of 15 patients had normal hemoglobin/hematocrit, ESR, and albumin at diagnosis. Endoscopic findings, all limited to the distal rectum, ranged from erythema to ulceration and polypoid lesions. Histology revealed characteristic findings. Stool softeners and mesalamine suppositories improved symptoms, but relapse was common. Conclusions SRUS in children presents with non-specific symptoms and endoscopic findings. Clinical suspicion is required, and diagnosis requires histologic confirmation. Response to current treatments is variable.

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“…Several histopathological studies emphasized that fibro-muscular obliteration, abundant deposition of collagen in the mucosa and abnormal extension of smooth muscle fibers with diamond shaped crypts are the main histological features that help differentiating SRU from ulcerative colitis [9][10][11][12] . SRU is very rarely associated with malignancy especially in young patients.…”

Section: Discussionmentioning

confidence: 99%

“…It has been found that inflammatory bowel disease mainly ulcerative colitis and rectal malignancy are the most common conditions that mistaken and represent diagnostic dilemma of SRU 11,14 . Other diagnostic tools such as MRI of pelvis, rectal and endoanal ultrasound, anal manometry, barium enema and defecography are of little help and their results are usually non specific 4,7,10,13 . The radiological picture of SRU by MRI characterized by appearance of thickened ulcerated mucosa in the anterior rectal wall which is usually indistinguishable from rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Ibrahim Falih Noori

Noori¹

2017

Basrah Journal of Surgery

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Solitary rectal ulcer (SRU) is rare benign disease of poorly understood etiology. The term solitary ulcer is misnomer because the lesion is solitary in only 20% of patients and ulcer present in 40% of the patients only. The lesion has various sizes and shapes that ranges from mucosal erythema to single or multiple ulcers to ulcer-nodular lesion or could be a polypoid or fungating mass. The estimated incidence of solitary rectal ulcer is about 1:100000 annually. Males and females are affected equally with slight predominance toward female patients. The disease can affect children and elderly patients also, although rare. The disease involves straining during defecation, a sense of incomplete evacuation, digital evacuation of the rectum, rectal prolapse and occasionally passing of blood and mucus by rectum. Clinical awareness confirmed by flexible sigmoidoscopy and biopsy are main diagnostic tools. Furthermore, the colonoscopic findings may mimic that of rectal cancer and inflammatory bowel disease and the histopathological results are inadequate due to fibrotic rectal mucosa. Treatment of solitary rectal ulcer depends on the severity of the condition with conservative measures, bowel regimen, and change of life style for mild cases and surgical procedure for sever refractory cases.

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Solitary rectal ulcer syndrome in association with ulcerative colitis: A case report

Cited by 5 publications

References 7 publications

The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases

The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases

Solitary Rectal Ulcer Syndrome in Children and Adolescents

Ibrahim Falih Noori

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