Transrectal ultrasound study of the pathogenesis of solitary rectal ulcer syndrome.

Outryve, Marc J. Van; Pelckmans, Paul; Fierens, H.; Maercke, Y. M. Van

doi:10.1136/gut.34.10.1422

Cited by 39 publications

(14 citation statements)

References 23 publications

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“…2). In the same manner, Van Outryve [22] described the disappearance of the typical five-layered rectal wall structure proximal to the SRUS ulcer. In our series, in pseudopolypoid lesions, the submucosa thickens and adopts a heterogeneous aspect, which can be easily confused with a cancer by ERUS (Figs 3 and 4).…”

Section: Discussionmentioning

confidence: 82%

“…Malde and Chadha [15], using a 7.5 MHz transrectal ultrasonography transducer, described a case of SRUS characterized by thick, hypoechoic growth disrupting the echogenic margin of the perirectal fat that was initially interpreted as a rectal carcinoma with mesorectal spread. Van Outryve [22], using a linear ultrasonographic probe, showed a thickening of the rectal wall in SRUS cases mainly due to a thickening of the muscularis propia. Conversely, Hizawa [16] showed a predominant thickening of the submucosa with preservation of the five-layer structure of the rectal wall and affirmed this characteristic as important in differentiating SRUS from other conditions such as malignant neoplasia and Crohn's disease.…”

Section: Discussionmentioning

confidence: 95%

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Solitary rectal ulcer

Blanco¹,

Frasson²,

Flor-Lorente³

et al. 2011

European Journal of Gastroenterology & Hepatology

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The objective of this study was to analyze a series of solitary rectal ulcer syndrome (SRUS) cases initially diagnosed as rectal cancer. We analyzed all the patients (1996-2008) initially referred to our colorectal unit with a diagnosis of rectal cancer but with a final diagnosis of SRUS. Demographic data, the diagnostic work-up, and treatment details were collected in a prospective database and analyzed retrospectively. Out of the 5035 patients registered in the colorectal unit database, 14 (0.28%) had a final diagnosis of SRUS. Nine of them had an initial diagnosis of rectal cancer. Out of these, six were preoperatively staged with endorectal ultrasound and/or magnetic resonance and were therefore analyzed for this study. Endorectal ultrasound was performed in all six patients and rectal cancer was diagnosed in five of them; MRI was performed in four patients and a diagnosis of rectal cancer was assessed in three of them; rectal cancer was finally ruled out in all cases by deep-forceps macrobiopsies. The incidence of misdiagnosis between SRUS and rectal cancer does not decrease with the regular use of imaging methods. Clinical judgment and deep-forceps macrobiopsies are essential in avoiding an erroneous diagnosis.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 95%

Solitary rectal ulcer

Blanco¹,

Frasson²,

Flor-Lorente³

et al. 2011

European Journal of Gastroenterology & Hepatology

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“…Defecography has also been reported to evaluate the puborectalis muscle's inappropriate contraction, which is useful mostly in patients with no response to primary treatments (55). Barium enema in SRU shows thickening of the rectal folds, stricture formation, polypoid lesions and ulceration, which can be very similar to malignant lesions (56).…”

Section: Other Diagnostic Methodsmentioning

confidence: 99%

Solitary Rectal Ulcer: A Literature Review

2015

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Context: Solitary rectal ulcer (SRU) is a disease with many challenging issues. There are several controversies about the basic pathophysiology of this disease. Despite its name, "solitary rectal ulcer", more than a quarter of patients do not show any ulcer in colonoscopy. Instead, many patients show multiple polypoid lesions. Some previous reports have suggested calling this disease "rectal mucosal prolapse" instead of SRU, however, most of the patients do not have mucosal prolapse. In addition, colonoscopic findings can be very similar to cancer and inflammatory bowel disease, so without histologic evaluation, accurate diagnosis is not always possible. In patients with SRU, sometimes the rectal mucosa is so fibrotic that mucosal biopsy is inadequate, and even a pathologist cannot diagnose the characteristic histologic findings. There are various therapeutic approaches for the treatment of SRU, both surgical and nonsurgical, all of which are not optimal, and recurrence rates are still high with many patients experiencing complications even after surgery, resection and rectopexy. Evidence Acquisition: Although this disease is not uncommon in Iran, there are very few studies from Iran, therefore, in this review we will describe our experience with patients with SRU in affiliated hospitals of Shiraz University of Medical Sciences. We will also review previously published articles about SRU that are indexed in PubMed and Google scholar, emphasizing the challenging issues. Results: SRU is not an uncommon disease in Iran, however the number of published articles about it, is very low. Multicentric studies are necessary to find out the definite reason of this issue. Conclusions: There are still many conflicting controversies about the etiology, pathogenesis, diagnosis and also treatment of SRU, which need further investigation and longer follow up of the patient in each therapeutic approach to be better understood.

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“…Typical features described on transrectal ultrasound include thickening of the muscularis propria and a lack of distinction between the mucosa and the muscularis propria [5]. Endoanal ultrasound can demonstrate marked thickening of the internal sphincter and thickening of the external sphincter and submucosa [6].…”

Section: Case Reportmentioning

confidence: 99%

Solitary rectal ulcer syndrome mimicking rectal neoplasm on MRI

Amaechi

Papagrigoriadis²,

Hizbullah

et al. 2010

BJR

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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).

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Transrectal ultrasound study of the pathogenesis of solitary rectal ulcer syndrome.

Cited by 39 publications

References 23 publications

Solitary rectal ulcer

Solitary rectal ulcer

Solitary Rectal Ulcer: A Literature Review

Solitary rectal ulcer syndrome mimicking rectal neoplasm on MRI

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