Solitary rectal ulcer syndrome
- David J Kim, MD
David J Kim, MD
- Northwest Gastroenterologists
- Peter A L Bonis, MD
Peter A L Bonis, MD
- Chief Medical Officer — UpToDate
- Deputy Editor — Gastroenterology/Hepatology
- Adjunct Professor of Medicine
- Tufts University School of Medicine
Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation [1,2]. The term solitary rectal ulcer syndrome is a misnomer. Endoscopic findings in patients with solitary rectal ulcer syndrome can range from mucosal erythema alone to single or multiple ulcers and polypoid/mass lesions. This topic will review the pathogenesis, clinical manifestations, diagnosis, and management of solitary rectal ulcer syndrome. Other causes of chronic colonic ulceration, including ulcerative colitis, Crohn disease, and ischemic colitis, are discussed in detail, separately. (See "Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults" and "Clinical manifestations, diagnosis and prognosis of Crohn disease in adults" and "Colonic ischemia".)
The incidence of solitary rectal ulcer syndrome is uncertain but has been estimated in one study to be 1 in 100,000 individuals per year . In one retrospective study of 80 patients, the median age at diagnosis was 48 years with a range of 14 to 76 years . Men and women appear to be affected equally, but a slight female preponderance has been suggested in various reports.
The pathogenesis of the solitary rectal ulcer is incompletely understood. However, a number of factors appear to have a causative role in individual reports. It is possible that different etiologies may contribute to the development of the final lesion.
A common observation in a number of reports is rectal prolapse and paradoxical contraction of the puborectalis muscle, which can result in rectal trauma by two different mechanisms [5,6]:
●Prolapsed rectal mucosa is forced downward due to the pressures generated by the rectum during defecation. The opposing force of the paradoxical contraction of the puborectalis muscle can generate high pressures within the rectum and lead to mucosal ischemia, thus predisposing to ulceration.
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- CLINICAL FEATURES
- Clinical manifestations
- Imaging findings
- Endoscopy and histology
- ADDITIONAL EVALUATION
- Endoscopic ultrasound
- DIFFERENTIAL DIAGNOSIS
- Management approach
- Conservative treatment
- SUMMARY AND RECOMMENDATIONS