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

Abstract

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.

Solitary Rectal Ulcer: A Literature Review

“…The age range of the patients is very similar in different geographic locations; the most common age of presentation has been between 15.5 and 43 years old. This disease is extremely rare after 70, and in elderly patients accompanying diseases, such as rectal cancer, should be investigated (8,10,13). Table 1 also shows that the number of SRU patients from our department, in the five years, is not low, and in comparison to other centers SRU seems to be more prevalent in Iran.…”

“…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.…”

A case of colitis cystica profunda in a patient with diverticulosis

“…Clinical presentation varies from completely asymptomatic to more specific symptoms such as mild lower bowel pain, diarrhea, mucous discharge, and rectal bleeding. Rectorrhagia followed by abdominal discomfort are the two most prevalent symptoms according to a large single-center experience [5]. Other symptoms such as rectal prolapse were also described [6].…”

Solitary Rectal Ulcer Syndrome in a Young Patient: A Case Report

“…Previously, SRUS and MPS were not considered as separate conditions. In recent articles, however, SRUS is categorized as a type of MPS, whereas MPS is classified as a category of the bowel diseases consisting of rectal prolapse, inflammatory cap polyp, proctitis cystica profunda (PCP), inflammatory cloacogenic polyp, inflammatory myoglandular polyp, and SRUS (4,5). Both MPS and SRUS may share the same clinical pathological features.…”