Solitary rectal ulcer syndrome

Czech version

Authors: R. Procházka; P. Srna; J. Frydrych
Authors‘ workplace: Oddělení gastroenterologie Nemocnice Jablonec nad Nisou
Published in: Gastroent Hepatol 2012; 66(4): 259-264
Category: Clinical and Experimental Gastroenterology: Review Article

Overview

The authors summarise the basic facts about and personal experience with a rare nosological disorder –⁠ solitary rectal ulcer syndrome (SRUS). In the first part, the pathophysiology and the diagnostics of SRUS are mentioned. The generally accepted theory of the development of SRUS is supported by the relevant citations. The symptoms and the endoscopic picture and in uncertain cases also the biopsy are the basis for the diagnosis of SRUS. In diagnostics, evacuation proctography is crucial especially with regard to SRUS therapy planning. In the second part, all the possible SRUS therapies are described. First in the line is conservative therapy. If conservative therapy fails, endoscopic therapy can be indicated but with limited options. The most causal is surgical therapy, which also offers the most options. Finally, the authors share their clinical experience with patients suffering from solitary rectal ulcer syndrome.

Key words:
rectal prolapse –⁠ solitary rectal ulcer –⁠ evacuation proctography

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
1. 6. 2012

Accepted:
26. 7. 2012

Sources

1. Madigan MR, Morson BC. Solitary ulcer of the rectum. Gut 1969; 10(11): 871–881.

2. Martin CJ, Parks TG, Biggart JD. Solitary rectal ulcer syndrom in Northern Ireland, 1971–1980. Br J Surg 1981; 68(10): 744–757.

3. Clair Eh Du Boulay, Fairbrother J, Isaacson PK. Mucosal prolaps syndrome –⁠ a unifying concept for solitary ulcer syndrom and related disorders, J Clin Pathol 1983; 36(11): 1264–1268.

4. Emmanuel AV, Kamm MA. Response to a behavioural treatment, biofeedback, in constipated patients is associated with improved gut transit and autonomic innervation. Gut 2001; 49(2): 214–219.

5. Jarrett MED, Emmanuel AV, Vaizey CJ et al. Behavioural therapy (biofeedback) for solitary rectal ulcer syndrom improves symptoms a mucosal blood flow. Gut 2004; 53(3): 368–370.

6. Lonsdale RN. Microvascular abnormalities in the mucosal prolapse syndrom. Gut 1993; 34(1): 106–109.

7. Womack NR, Williams NS, Holmfield JHM et al. Pressure and prolaps-the cause of solitary rectal ulceration. Gut 1987; 28(10): 1228–1233.

8. Sharara AI, Azar C, Amr SS et al. Solitary rectal ulcer syndrome: endoscopic spectrum and review of the literature. Gastrointest Endosc 2005; 62(5): 755–762.

9. Kang YS, Kamm MA, Engel AF et al. Pathology of the rectal wall in solitary rectal ulcer syndrom and complete rectal prolaps, Gut 1996; 38(4): 587–590.

10. Halligan S, Nicholls RJ, Bartram CI. Evacuation Proctography in Patiens with Solitary Rectal Ulcer Syndrom. Am J Roentgenol 1995; 164(1): 91–95.

11. Van Outryve MJV, Pelckmans PA, Fierens H et al. Transrectal ultrasound study of the pathogenesis of solitary rectal ulcer syndrome. Gut 1993; 34(10): 1422–1426.

12. van den Brandt-Grädel V, Huibregtse K, Tytgat GNJ. Treatment of solitary rectal ulcer syndrome with high-fiber diet and abstention of straining at defecation. Dig Dis Sci 1984; 29(11): 1005–1008.

13. Malouf AJ, Vaizey CJ, Kamm MA. Results of Behavioral Treatment (Biofeedback) for Solitary Rectal Ulcer Syndrom. Dis Colon Rectum 2001; 44(1): 72–76.

14. Boccasanta P, Ventura M, Calabro G et al. Stapled Transanal Rectal Resection in Solitary Rectal. Dis Colon Rectum 2008; 51(3): 348–354.

15. Zargar SA, Khuroo MS, Mahajan R. Sucralfate retention enemas in solitary rectal ulcer. Dis Colon Rectum 1991; 34(6): 455–457.

16. Kochhar R, Mehta SK, Aggarwal R et al. Sucralfate enema in ulcerative rectosigmoid lesions. Dis Colon Rectum 1990; 33(1): 49–51.

17. Somani SK, Ghosh A, Avasthi G et al. Healing of solitary rectal ulcers with multiple sessions of argon plasma coagulation. Dig Endosc 2010; 22(2): 107–111.

18. Ederle A, Bulighin G, Orlandi PG et al. Endoscopic application of human fibrin sealant in the treatment of solitary rectal ulcer syndrome. Endoscopy 1992; 24(8): 736–737.

19. Simsek A, Yagci G, Gorgulu S et al. Diagnostic Features and Treatment Modalities in Solitary Rectal Ulcer Syndrome, Acta Chir Belg 2004; 104(1): 92–96.

20. Abid S, Khawaja A, Bhimani SA et al. The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases. BMC Gastroenterol 2012; 12(1): 72.

21. Stoppino V, Cuomo R, Tonti P et al. Argon plasma coagulation of hemorrhagic solitary rectal ulcer syndrome, J Clin Gastroenterol 2003; 37(5): 392–394.

22. Chong VH, Jalihal A. Solitary rectal ulcer syndrom: characteristic, outcomes and predictive profiles for persistent bleeding per rectum. Singapore Med J 2006; 42(12): 1063–1068.