Materiały źródłowe

• #1 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. […] The aim of the present review is to summarize the clinical features, pathophysiology, diagnostic methods and treatment strategies associated with SRUS. […] The clinical presentation varies, therefore, early diagnosis requires a high index of suspicion from both the surgeon and the pathologist, especially because the term solitary rectal ulcer is a misnomer and only a quarter of the adults with SRUS have a true rectal ulcer, and the lesion is not necessarily solitary or ulcerated.

• #2 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  Solitary rectal ulcer syndrome is a multifactorial pathology, which entails a variety of clinical, histologic and endoscopic aspects that needs step-wise logical approach for management especially in relapsing refractory cases. […] The vague definition of SRUS, its wide range of endoscopic findings and overlapping symptoms, make it hard to distinguish this somehow rare condition from more serious diseases such as inflammatory bowel disease. […] The diagnosis of solitary rectal ulcer syndrome is based on clinical, endoscopic and histopathologic aspects. Since the two former categories are not so specific, the diagnosis should be confirmed by histologic findings to prevent misdiagnoses. […] The endoscopic findings vary from simple mucosal erythematous patch to a solitary or multiple ulcers. However, endoscopy may also reveal non-ulcerative polypoid or mass lesions.

• #3 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921483/

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. […] Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] It has been recommended that defecography and anorectal manometry should be performed in all children with SRUS to define the primary pathophysiological abnormality and to select the most appropriate treatment protocol. […] The diagnosis can be made clinically, endoscopically, and histologically.

• #4 Clinical and laboratory characteristics of solitary rectal ulcer syndrome: a retrospective analysis of 36 case | Scientific Reports

  https://www.nature.com/articles/s41598-025-86324-0

  The diagnostic challenge of SRUS is well documented, with many ulcerative or hyperemic lesions often misidentified as inflammatory bowel diseases. A key histological feature that distinguishes SRUS from these other conditions is the obliteration of fibromuscular tissue in the lamina propria, which serves as a highly sensitive marker. […] The clinical characteristics and findings of our case series underscore the rarity and chronic nature of SRUS, with an incidence of 1 per 100,000 adults. Although this condition is benign, it is frequently misdiagnosed, with up to 26% of patients having an incorrect initial diagnosis.

• #5 Clinical and laboratory characteristics of solitary rectal ulcer syndrome: a retrospective analysis of 36 case | Scientific Reports

  https://www.nature.com/articles/s41598-025-86324-0

  The primary objective of this study was to evaluate the clinical, laboratory, and histological characteristics of solitary rectal ulcer syndrome (SRUS) and assess the outcomes associated with various management strategies. […] The diagnosis of SRUS presents a significant challenge owing to its varied presentation and overlap with other gastrointestinal conditions, such as inflammatory bowel disease, infectious proctitis, and ischemic colitis. Endoscopic examination typically reveals ulceration, erythema, and polypoid lesions, predominantly located on the anterior rectal wall. Histopathologically, SRUS is characterized by fibromuscular obliteration of the lamina propria, crypt distortion, and inflammatory infiltrates, distinguishing it from other colonic pathologies. […] SRUS diagnosis was established based on a combination of clinical symptoms, endoscopic findings, and histopathological confirmation. Clinical symptoms include rectal bleeding, mucus discharge, straining during defecation, and a sensation of incomplete evacuation. Endoscopic examination revealed ulceration, erythema, or polypoid lesions predominantly located on the anterior rectal wall. Histopathological analysis confirmed the diagnosis by demonstrating fibromuscular obliteration of the lamina propria, crypt distortion, and inflammatory infiltration.

• #6 Solitary rectal ulcer syndrome – UpToDate

  https://www.uptodate.com/contents/solitary-rectal-ulcer-syndrome

  Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. […] 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 features, diagnosis, and management of solitary rectal ulcer syndrome. […] A common observation in a number of reports is rectal prolapse or rectal intussusception and paradoxical contraction of the puborectalis muscle. […] A case-control study compared anorectal physiology and defecation proctography in 25 patients with solitary rectal ulcer syndrome with matched controls with either outlet obstruction, overt rectal prolapse without any mucosal change, or overt rectal prolapse with mucosal changes. […] Patients with solitary rectal ulcer syndrome more frequently had increasing anal pressure at straining, paradoxical puborectalis contraction, and prolapse of the inner circular smooth muscle of the rectum and less frequently had complete rectal emptying compared with controls.

• #7

  https://link.springer.com/article/10.1007/BF02051170

  Solitary rectal ulcer syndrome (SRUS) often goes unrecognized or is misdiagnosed. Of 98 patients with a final clinicopathologic diagnosis of SRUS, an initially incorrect diagnosis had been made in 25 patients (26 percent). […] In these 25 patients with a misdiagnosis, the median age was 43 years and the female-to-male ratio was 3.21. The median duration of incorrect diagnosis was five years (range, three months to 30 years), and seven patients received prednisone (30 mg/day) for a mistaken diagnosis of inflammatory bowel disease. […] Original rectal biopsy specimens from 23 patients were reviewed; inadequate specimens and failure to recognize diagnostic features of SRUS contributed to delayed diagnosis in 13 and 10 patients, respectively. […] Persistent bowel symptoms and rectal lesions led to review of the presentations and repeat biopsy directed toward the edge of the rectal ulcers or from within the polypoid or hyperemic rectal lesions, finally establishing the diagnosis of SRUS.

• #8 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] Colonoscopy and biopsy of normal and abnormal-looking rectal and colonic mucosa should be performed. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] As a result of the wide endoscopic spectrum of SRUS and the fact that the condition may go unrecognized or, more commonly, misdiagnosed, it is crucial to collect biopsy specimens from the involved area to confirm the diagnosis and to exclude other diagnoses, including cancer. […] Anorectal manometry and electromyography provide useful information about anorectal inhibitory reflex, pressure profiles, defecation dynamics, and rectal compliance and sensory thresholds.

• #9 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921483/

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. […] Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] It has been recommended that defecography and anorectal manometry should be performed in all children with SRUS to define the primary pathophysiological abnormality and to select the most appropriate treatment protocol. […] The diagnosis can be made clinically, endoscopically, and histologically.

• #10 Solitary rectal ulcer syndrome – UpToDate

  https://www.uptodate.com/contents/solitary-rectal-ulcer-syndrome

  Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. […] 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 features, diagnosis, and management of solitary rectal ulcer syndrome. […] A common observation in a number of reports is rectal prolapse or rectal intussusception and paradoxical contraction of the puborectalis muscle. […] A case-control study compared anorectal physiology and defecation proctography in 25 patients with solitary rectal ulcer syndrome with matched controls with either outlet obstruction, overt rectal prolapse without any mucosal change, or overt rectal prolapse with mucosal changes. […] Patients with solitary rectal ulcer syndrome more frequently had increasing anal pressure at straining, paradoxical puborectalis contraction, and prolapse of the inner circular smooth muscle of the rectum and less frequently had complete rectal emptying compared with controls.

• #11 Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

  https://www.jnmjournal.org/journal/view.html?volume=20&number=4&spage=531

  Using Rome III criteria, most patients with SRUS reported having chronic constipation (36/40 [90%]) in spite of having normal (Bristol stool type IV, 21/40 [53%]) and diarrheal (types V, VI, VII, 6/40 [20%]) stool forms (Asian classification). […] SRUS patients more often (17/40 [43%]) had functional defecation disorder (Rome III criteria). […] FED was commoner among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal sphincter on EUS than those without. […] Seventeen of 40 (42.5%) patients with SRUS fulfilled the Rome III criteria for functional defecation disorder (chronic constipation and abnormalities in 2 physiological test parameters). […] The present study showed that, patients with SRUS (1) more often had chronic constipation by the Rome III criteria, (2) had FED as compared to HC as documented by BET and impaired anal relaxation, (3) more than half of patients with SRU had abnormal defecography, (4) about 40% of the patients with SRU had functional defecation disorders according to the Rome III criteria and (5) those with abnormal BET had thicker IAS than those without. […] We found that a large proportion of patients with SRU had underlying FED and those with FED had thicker IAS. However, whether FED and increased IAS thickness are causes or effects of SRUS is not known.

• #12 Solitary Rectal Ulcer Syndrome: Symptoms, Tests & Treatment

  https://my.clevelandclinic.org/health/diseases/21189-rectal-ulcers

  Solitary rectal ulcer syndrome involves having one or more benign (noncancerous) sores inside your rectum. […] Treatments include lifestyle changes that allow you to pass stools more easily, prescription medications, biofeedback and surgery. […] Your healthcare provider will ask about your symptoms and bathroom habits that may have caused your symptoms (like frequently straining to poop). To check for rectal ulcers, providers use digital rectal exams and imaging tests. […] The most common test is an: Endoscopy: Your provider may insert a scope inside you to check for ulcers. […] You may need additional tests so your provider can rule out conditions that cause symptoms similar to solitary rectal ulcer syndrome, like inflammatory bowel disease (IBD) and colon cancer. […] Treatment for solitary rectal ulcer syndrome depends on the severity of your symptoms and whats causing them.

• #13

  https://journals.lww.com/ajg/fulltext/2021/10001/s1891_solitary_rectal_ulcer_syndrome__complicated.1895.aspx

  Solitary rectal ulcer syndrome (SRUS) is diagnosed clinically via history and physical, endoscopy, and histology. […] Although this patient was diagnosed with SRUS on initial visit with gastroenterology, failure to treat conservatively was due to lack of proper food choices complicated by rectal intussusception. […] This case additionally reinforces how internal rectal intussusception should be considered as an underlying cause in SRUS especially when symptoms persist despite conservative measures.

• #14 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422

  Solitary rectal ulcer syndrome (SRUS) is a benign rectal disease that is rare in pediatric populations due to its underdiagnosis and misdiagnosis in children. […] It is often misdiagnosed as malignancy, Crohns disease, and ulcerative colitis due to its wide and varying clinical presentations. […] Both SRUS and inflammatory bowel disease (IBD) can present with rectal bleeding, constipation, diarrhea, and abdominal pain. […] Furthermore, macroscopic ulcers and inflammation can be seen in both diseases, making it difficult to diagnose without a biopsy. […] These cases emphasize the difficulty and importance of differentiating between IBD and SRUS, and should encourage practitioners to include this differential diagnosis earlier on to improve diagnostic accuracy and begin implementing effective treatment.

• #15 Solitary rectal ulcer syndrome: Is it really a rare condition in children?

  https://www.wjgnet.com/2219-2808/full/v5/i3/343.htm

  The aim of this study was to assess the children diagnosed with solitary rectal ulcer in Southern Iran. […] The diagnosis of solitary rectal ulcer in our patients was based on the clinical history, colonoscopic and histopathological findings of rectosigmoid biopsies. […] In this study, 55 children with the final diagnosis of solitary rectal ulcer were evaluated in 11 years, and to the best of our knowledge it is the largest pediatric series in the world. […] According to this study and other related studies, it seems that rectal bleeding is the most common symptom; other less common symptoms were mucorrhea and straining during defecation which can be easily obtained from the patients history. […] Therefore, the physicians should be aware of this disorder and thus prevent the late diagnosis of the disease and prevent its long term complications.

• #16 Solitary Rectal Ulcer Syndrome: Symptoms, Tests & Treatment

  https://my.clevelandclinic.org/health/diseases/21189-rectal-ulcers

  Solitary rectal ulcer syndrome involves having one or more benign (noncancerous) sores inside your rectum. […] Treatments include lifestyle changes that allow you to pass stools more easily, prescription medications, biofeedback and surgery. […] Your healthcare provider will ask about your symptoms and bathroom habits that may have caused your symptoms (like frequently straining to poop). To check for rectal ulcers, providers use digital rectal exams and imaging tests. […] The most common test is an: Endoscopy: Your provider may insert a scope inside you to check for ulcers. […] You may need additional tests so your provider can rule out conditions that cause symptoms similar to solitary rectal ulcer syndrome, like inflammatory bowel disease (IBD) and colon cancer. […] Treatment for solitary rectal ulcer syndrome depends on the severity of your symptoms and whats causing them.

• #17 Rectal Ulcer: Symptoms, Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/rectal-ulcer

  In rare cases, rectal ulcers can also develop without an obvious cause if you have a condition called solitary rectal ulcer syndrome (SRUS). SRUS often means youll have rectal ulcers without any other symptoms like pain or changes in your stool. […] A medical professional will usually ask for a medical history and do a physical exam to check your overall health. This may include a digital rectal exam (DRE) to check for signs of injury or disease. […] Imaging tests are often needed to look more closely at the rectum to confirm a diagnosis, including: X-ray, ultrasound, MRI. […] A sigmoidoscopy or colonoscopy may be needed to look further inside your rectum and colon. These tests are done by inserting a thin tube with a light and camera into your rectum to get real-time, detailed images of your rectum. […] A medical professional may also take a tissue sample (biopsy) from your ulcer to test it for infections or cancer.

• #18 Solitary Rectal Ulcer Syndrome in Children: A Report of Six Cases

  https://www.gutnliver.org/journal/view.html?volume=7&number=6&spage=752

  Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. […] This syndrome is diagnosed based on clinical symptoms and endoscopic and histological findings, but SRUS often goes unrecognized or is easily confused with other diseases such as inflammatory bowel disease, amoebiasis, malignancy, and other causes of rectal bleeding such as juvenile polyps. […] The diagnosis of the syndrome is based on clinical symptoms and endoscopic and histological findings. […] SRUS should be suspected in patients with rectal discharge of blood and mucus and previous disorders of evacuation. […] Histological examination is the gold standard for establishing the diagnosis of SRUS. […] It is mandatory to take biopsy specimens from the involved area to confirm the diagnosis and to exclude other diseases.

• #19 Solitary rectal ulcer syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/diagnosis-treatment/drc-20377754

  You may have one or more of the following tests to diagnose solitary rectal ulcer syndrome: […] During this test, your doctor inserts a thin, flexible tube with a tiny camera into your rectum to examine your rectum and part of your colon. If a lesion is found, your doctor may take a tissue sample for laboratory testing. […] Your doctor may recommend an ultrasound to help differentiate solitary rectal ulcer syndrome from other conditions. […] Your doctor may order an imaging study called defecation proctography. In this study, a soft paste made of barium is inserted into your rectum. […] Specialized centers may offer a similar test called magnetic resonance defecography. This test is done with a magnetic resonance imaging machine and provides a 3D image of the rectum.

• #20 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] Colonoscopy and biopsy of normal and abnormal-looking rectal and colonic mucosa should be performed. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] As a result of the wide endoscopic spectrum of SRUS and the fact that the condition may go unrecognized or, more commonly, misdiagnosed, it is crucial to collect biopsy specimens from the involved area to confirm the diagnosis and to exclude other diagnoses, including cancer. […] Anorectal manometry and electromyography provide useful information about anorectal inhibitory reflex, pressure profiles, defecation dynamics, and rectal compliance and sensory thresholds.

• #21 Solitary rectal ulcer syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/diagnosis-treatment/drc-20377754

  You may have one or more of the following tests to diagnose solitary rectal ulcer syndrome: […] During this test, your doctor inserts a thin, flexible tube with a tiny camera into your rectum to examine your rectum and part of your colon. If a lesion is found, your doctor may take a tissue sample for laboratory testing. […] Your doctor may recommend an ultrasound to help differentiate solitary rectal ulcer syndrome from other conditions. […] Your doctor may order an imaging study called defecation proctography. In this study, a soft paste made of barium is inserted into your rectum. […] Specialized centers may offer a similar test called magnetic resonance defecography. This test is done with a magnetic resonance imaging machine and provides a 3D image of the rectum.

• #22 Solitary Rectal Ulcer Syndrome – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/solitary-rectal-ulcer-syndrome

  Solitary rectal ulcer syndrome is a rare disorder that involves straining during defecation, a sense of incomplete evacuation, and sometimes passage of blood and mucus by rectum. […] Diagnosis is clinical with confirmation by flexible sigmoidoscopy and sometimes biopsy. […] Diagnosis of solitary rectal ulcer syndrome is typically made by clinical history and flexible sigmoidoscopy, but biopsy is sometimes done for confirmation. […] Assessment for internal or full-thickness rectal prolapse should be done (see diagnosis of rectal prolapse).

• #23 Solitary rectal ulcer syndrome – UpToDate

  https://www.uptodate.com/contents/solitary-rectal-ulcer-syndrome

  Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. […] 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 features, diagnosis, and management of solitary rectal ulcer syndrome. […] A common observation in a number of reports is rectal prolapse or rectal intussusception and paradoxical contraction of the puborectalis muscle. […] A case-control study compared anorectal physiology and defecation proctography in 25 patients with solitary rectal ulcer syndrome with matched controls with either outlet obstruction, overt rectal prolapse without any mucosal change, or overt rectal prolapse with mucosal changes. […] Patients with solitary rectal ulcer syndrome more frequently had increasing anal pressure at straining, paradoxical puborectalis contraction, and prolapse of the inner circular smooth muscle of the rectum and less frequently had complete rectal emptying compared with controls.

• #24

  https://www.omjournal.org/articleDetails.aspx?coType=1&aId=160

  Solitary rectal ulcer syndrome is common in adults; however, it is thought to be rare in children. The main presenting feature of solitary rectal ulcer syndrome is rectal bleeding, but the clinical diagnosis and treatment remain challenging, particularly in pediatric patients. […] Although common in adults, solitary rectal ulcer syndrome is thought to be rare in children. Its etiology is unknown, and its exact pathogenesis is poorly understood. It usually presents as bleeding from the rectum. Its clinical diagnosis and treatment remain challenging, particularly in pediatric patients. […] Proctosigmoidoscopy is always diagnostic. Rectal ulcers may be single or multiple. Three types of lesions have been described; ulcerative, polypoid and flat types. The most common type is ulcerative. A typical ulcer is shallow, with a white sloughy base and a thin rim of erythematous and edematous mucosa.

• #25 Solitary rectal ulcer syndrome and enterocele in a 13-year-old boy

  https://www.termedia.pl/Solitary-rectal-ulcer-syndrome-and-enterocele-in-a-13-year-old-boy,41,21157,1,1.html

  Solitary rectal ulcer syndrome (SRUS) is the term used to describe a wide spectrum of abnormalities affecting mainly young adults with varied clinical presentation, protean endoscopic appearance, yet characteristic histopathological findings. […] Accurate diagnosis and treatment of SRUS still remains a clinical challenge for several reasons. […] A typical histology with the presence of fibromuscular obliteration of the lamina propria and disorientation of muscle fibers is crucial for a diagnosis. […] The pediatric experience with this condition is limited and there is a lack of diagnostic and therapeutic protocols. […] To our knowledge this is the first case of documented enterocele in a pediatric SRUS patient. […] A typical SRUS appears as isolated erythema or a shallow and solitary ulcerating lesion highlighted by erythematous mucosa, usually located on the anterior rectal wall, several centimeters from the anal verge.

• #26 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  Solitary rectal ulcer syndrome is a multifactorial pathology, which entails a variety of clinical, histologic and endoscopic aspects that needs step-wise logical approach for management especially in relapsing refractory cases. […] The vague definition of SRUS, its wide range of endoscopic findings and overlapping symptoms, make it hard to distinguish this somehow rare condition from more serious diseases such as inflammatory bowel disease. […] The diagnosis of solitary rectal ulcer syndrome is based on clinical, endoscopic and histopathologic aspects. Since the two former categories are not so specific, the diagnosis should be confirmed by histologic findings to prevent misdiagnoses. […] The endoscopic findings vary from simple mucosal erythematous patch to a solitary or multiple ulcers. However, endoscopy may also reveal non-ulcerative polypoid or mass lesions.

• #27 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] Colonoscopy and biopsy of normal and abnormal-looking rectal and colonic mucosa should be performed. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] As a result of the wide endoscopic spectrum of SRUS and the fact that the condition may go unrecognized or, more commonly, misdiagnosed, it is crucial to collect biopsy specimens from the involved area to confirm the diagnosis and to exclude other diagnoses, including cancer. […] Anorectal manometry and electromyography provide useful information about anorectal inhibitory reflex, pressure profiles, defecation dynamics, and rectal compliance and sensory thresholds.

• #28 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  Solitary rectal ulcer syndrome is a multifactorial pathology, which entails a variety of clinical, histologic and endoscopic aspects that needs step-wise logical approach for management especially in relapsing refractory cases. […] The vague definition of SRUS, its wide range of endoscopic findings and overlapping symptoms, make it hard to distinguish this somehow rare condition from more serious diseases such as inflammatory bowel disease. […] The diagnosis of solitary rectal ulcer syndrome is based on clinical, endoscopic and histopathologic aspects. Since the two former categories are not so specific, the diagnosis should be confirmed by histologic findings to prevent misdiagnoses. […] The endoscopic findings vary from simple mucosal erythematous patch to a solitary or multiple ulcers. However, endoscopy may also reveal non-ulcerative polypoid or mass lesions.

• #29 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422/374

  Solitary rectal ulcer syndrome (SRUS) is a benign rectal disease that is rare in pediatric populations due to its underdiagnosis and misdiagnosis in children. […] Diagnosis is made based on clinical symptoms, colonoscopy findings, and histologic finding of fibromuscular obliteration of the lamina propria. […] Inflammatory bowel disease (IBD) and tumors are differentiated from SRUS with histopathology findings: SRUS shows lamina propria scarring and mild inflammatory infiltrate and muscular hyperplasia. […] Although the pathophysiology of SRUS is not well known, it is hypothesized that chronic damage to the mucosa from direct trauma or local ischemia caused by tenesmus, straining during constipation, intussusception of the rectal mucosa, and inflammation from hard stools may play a role.

• #30 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] Colonoscopy and biopsy of normal and abnormal-looking rectal and colonic mucosa should be performed. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] As a result of the wide endoscopic spectrum of SRUS and the fact that the condition may go unrecognized or, more commonly, misdiagnosed, it is crucial to collect biopsy specimens from the involved area to confirm the diagnosis and to exclude other diagnoses, including cancer. […] Anorectal manometry and electromyography provide useful information about anorectal inhibitory reflex, pressure profiles, defecation dynamics, and rectal compliance and sensory thresholds.

• #31 Solitary Rectal Ulcer Syndrome Is Not Always Ulcerated: A Case Report

  https://www.mdpi.com/1648-9144/58/8/1136

  Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults that is characterized by a series of symptoms such as rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, a feeling of incomplete defecation, constipation and, rarely, rectal prolapse. […] The etiology of this syndrome remains obscure, and the diagnosis is easily confused with that of other diseases, contributing to difficulties in treatment. […] The diagnosis of SRUS can usually be performed by a combination of symptomatology, endoscopy and histology. […] However, patients sometimes have typical symptoms without typical endoscopic findings. […] Not all SRUS cases present ulcers. Patients with typical symptoms and nonulcerated rectal lesions should be differentiated from those with superficial rectal cancer. Magnifying NBI and chromoendoscopy are useful, and histopathological examination should be performed to confirm the diagnosis.

• #32 Solitary Rectal Ulcer Syndrome Is Not Always Ulcerated: A Case Report

  https://www.mdpi.com/1648-9144/58/8/1136

  Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults that is characterized by a series of symptoms such as rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, a feeling of incomplete defecation, constipation and, rarely, rectal prolapse. […] The etiology of this syndrome remains obscure, and the diagnosis is easily confused with that of other diseases, contributing to difficulties in treatment. […] The diagnosis of SRUS can usually be performed by a combination of symptomatology, endoscopy and histology. […] However, patients sometimes have typical symptoms without typical endoscopic findings. […] Not all SRUS cases present ulcers. Patients with typical symptoms and nonulcerated rectal lesions should be differentiated from those with superficial rectal cancer. Magnifying NBI and chromoendoscopy are useful, and histopathological examination should be performed to confirm the diagnosis.

• #33 Solitary Rectal Ulcer Syndrome in Children: A Report of Six Cases

  https://www.gutnliver.org/journal/view.html?volume=7&number=6&spage=752

  Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. […] This syndrome is diagnosed based on clinical symptoms and endoscopic and histological findings, but SRUS often goes unrecognized or is easily confused with other diseases such as inflammatory bowel disease, amoebiasis, malignancy, and other causes of rectal bleeding such as juvenile polyps. […] The diagnosis of the syndrome is based on clinical symptoms and endoscopic and histological findings. […] SRUS should be suspected in patients with rectal discharge of blood and mucus and previous disorders of evacuation. […] Histological examination is the gold standard for establishing the diagnosis of SRUS. […] It is mandatory to take biopsy specimens from the involved area to confirm the diagnosis and to exclude other diseases.

• #34 The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-12-72

  Solitary 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. […] Diagnosis of SRUS was based on characteristic endoscopic and histological findings. […] Histological analysis is considered to be the cornerstone for diagnosing SRUS with fibromuscular obliteration being the characteristic finding. […] A high index of suspicion is therefore required to diagnose potentially serious disease by repeated examinations and biopsies for histopathology.

• #35

  https://journals.lww.com/md-journal/fulltext/2018/05040/solitary_rectal_ulcer_syndrome__a_systematic.18.aspx

  Solitary rectal ulcer (SRUS) may mislead the inflammatory bowel disease (IBD) or rectal polyps, which may reduce the actual prevalence of it. […] The occurrence of symptoms affects the probability of the disease, and its diagnosis is by direct examination of the lesion by colonoscopy and histological study of lesion. However, the etiology, pathophysiology, and clinical manifestations of SRUS are not fully understood. Given different clinical symptoms and endoscopic findings, SRUS may be confused with disorders such as inflammatory bowel disease (IBD) and neoplasms. […] The diagnosis of SRUS can usually be performed by combination of symptomatology, endoscopy, sigmoidoscopy, and histology. […] The syndrome is characterized by histological features, the importance of which can be summarized according to the following characteristic appearance: Thickening of the mucosal layer along with crypts distortion; Fibromuscular obliteration in the lamina propria has been reported to be the cornerstone for diagnosing SRUS.

• #36 Solitary Rectal Ulcer Syndrome in Children: A Report of Six Cases

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=527&vmd=Full

  The diagnosis of the syndrome is based on clinical symptoms and endoscopic and histological findings. […] SRUS should be suspected in patients with rectal discharge of blood and mucus and previous disorders of evacuation. […] Histological examination is the gold standard for establishing the diagnosis of SRUS. The histological criteria for diagnosis include a thickened mucosal layer with distortion of the crypt architecture and fibromuscular obliteration which means that the lamina propria is replaced with smooth muscle and collagen leading to hypertrophy and disorganisation of the muscularis mucosa. […] It is mandatory to take biopsy specimens from the involved area to confirm the diagnosis and to exclude other diseases.

• #37 Solitary Rectal Ulcer Syndrome – A Rare Entity in the Pediatric Population – Turkish Journal of Pathology

  https://turkjpath.org/text.php?id=2082

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disorder of defecation with an estimated incidence of 1 case per 100,000 adults per year, with few pediatric cases noted. […] The most commonly accepted etiopathogenetic mechanism of SRUS is a hypoperfusion-induced chronic mucosal ischemic injury to the rectal mucosa. […] Clinically, the patient presents with abdominal pain, constipation, and bleeding per rectum. […] On endoscopy, the ulcer appears as a shallow-based ulcerating lesion encircled by hyperemic mucosa. […] SRUS is a misnomer, as the patient may present with multiple ulcers rather than a solitary ulcer. […] Endoscopy and histopathology help to diagnose SRUS. […] Characteristic histopathological findings of SRUS include fibromuscular obliteration of the lamina propria, hypertrophied muscularis mucosa with extension of muscle fibers upward (between the crypts), and glandular crypt abnormalities.

• #38

  https://www.tropicalgastro.com/printerfriendly.aspx?id=1362

  Solitary rectal ulcer syndrome (SRUS) is diagnosed on the basis of clinical symptoms, endoscopic and histological findings. […] The diagnosis of SRUS is based on symptomatology in combination with endoscopic and histologic findings. […] Histopathology is mainspring for the diagnosis of SRUS and also for excluding any other underlying diseases. […] Biopsy is also mandatory in patients with endoscopic evidence of SRUS to rule out malignancy. […] The endoscopic findings in the present study revealed ulcerative lesion in 87% of patients with solitary lesion in only 44 %, hence the term SRUS is misleading. […] The most common diagnostic confusion was with inflammatory bowel disease and neoplastic polyp. […] The histological findings are highly characteristic despite the inconsistency and discrepancy on the clinical and endoscopic findings. Key histological features include fibromuscular obliteration of the lamina propria with splaying of muscularis mucosa upward between the crypts, thickened mucosa and glandular distortion.

• #39 Solitary rectal ulcer in a teenage patient | Gastroenterología y Hepatología (English Edition)

  https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-english-edition–382-articulo-solitary-rectal-ulcer-in-teenage-S2444382416301092

  Solitary rectal ulcer syndrome (SRUS) is an exceptional disorder in paediatric and adolescent patients. It is often confused with other conditions, such as inflammatory bowel disease (IBD), delaying its diagnosis for years after the first consultation. […] Rectoscopy with biopsies is essential for diagnosis. The typical finding is a superficial ulcerated lesion of variable morphology (round, oval, linear or serpiginous) surrounded by an erythematous halo and located in the anterior or antero-lateral wall of the rectum. However, the lesion is not always solitaryit can be multiple or circumferential as in our casenor ulcerated, with hyperaemic or polypoid lesions also having been described. […] The histological findings are characteristic: thickening of the mucosa, elongation and distortion of the glands, oedematous lamina propria with a large amount of collagen and variable proliferation of fibroblasts, and thickening of the muscularis mucosae, with muscle fibres that ascend vertically.

• #40

  https://www.tropicalgastro.com/printerfriendly.aspx?id=1362

  In our study, we found fibromuscular obliteration in all cases and surface ulceration in more than half of the patients. […] The balloon expulsion test was significantly abnormal in SRUS patients compared to that in healthy controls (53% vs. 20%, p 0.01). […] Abnormal anal relaxation was more frequently found in SRUS patients than in controls.

• #41 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422/374

  Solitary rectal ulcer syndrome (SRUS) is a benign rectal disease that is rare in pediatric populations due to its underdiagnosis and misdiagnosis in children. […] Diagnosis is made based on clinical symptoms, colonoscopy findings, and histologic finding of fibromuscular obliteration of the lamina propria. […] Inflammatory bowel disease (IBD) and tumors are differentiated from SRUS with histopathology findings: SRUS shows lamina propria scarring and mild inflammatory infiltrate and muscular hyperplasia. […] Although the pathophysiology of SRUS is not well known, it is hypothesized that chronic damage to the mucosa from direct trauma or local ischemia caused by tenesmus, straining during constipation, intussusception of the rectal mucosa, and inflammation from hard stools may play a role.

• #42

  https://journals.lww.com/md-journal/fulltext/2018/05040/solitary_rectal_ulcer_syndrome__a_systematic.18.aspx

  Solitary rectal ulcer (SRUS) may mislead the inflammatory bowel disease (IBD) or rectal polyps, which may reduce the actual prevalence of it. […] The occurrence of symptoms affects the probability of the disease, and its diagnosis is by direct examination of the lesion by colonoscopy and histological study of lesion. However, the etiology, pathophysiology, and clinical manifestations of SRUS are not fully understood. Given different clinical symptoms and endoscopic findings, SRUS may be confused with disorders such as inflammatory bowel disease (IBD) and neoplasms. […] The diagnosis of SRUS can usually be performed by combination of symptomatology, endoscopy, sigmoidoscopy, and histology. […] The syndrome is characterized by histological features, the importance of which can be summarized according to the following characteristic appearance: Thickening of the mucosal layer along with crypts distortion; Fibromuscular obliteration in the lamina propria has been reported to be the cornerstone for diagnosing SRUS.

• #43 Solitary rectal ulcer syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Solitary_rectal_ulcer_syndrome

  Solitary rectal ulcer syndrome (SRUS) is a chronic disorder of the rectal mucosa (the lining of the rectum). […] Diagnosis is difficult because of rarity of the condition and because of the variability of the symptoms and the histologic appearance. […] The condition is sometimes misdiagnosed. […] Diagnosis may be delayed by many years as a result. […] Investigations used in the diagnosis of SRUS include defecography, endoanal ultrasound, colonoscopy and histological examination of a biopsy. […] The macroscopic appearance of SRUS is very variable. […] Classically, there is a solitary ulcer. […] The histological appearance is as follows: segmental and superficial (shallow) ulceration. […] This feature differentiates SRUS from inflammatory bowel disease, and is the landmark diagnostic feature for SRUS.

• #44

  https://link.springer.com/article/10.1007/BF02051170

  Solitary rectal ulcer syndrome (SRUS) often goes unrecognized or is misdiagnosed. Of 98 patients with a final clinicopathologic diagnosis of SRUS, an initially incorrect diagnosis had been made in 25 patients (26 percent). […] In these 25 patients with a misdiagnosis, the median age was 43 years and the female-to-male ratio was 3.21. The median duration of incorrect diagnosis was five years (range, three months to 30 years), and seven patients received prednisone (30 mg/day) for a mistaken diagnosis of inflammatory bowel disease. […] Original rectal biopsy specimens from 23 patients were reviewed; inadequate specimens and failure to recognize diagnostic features of SRUS contributed to delayed diagnosis in 13 and 10 patients, respectively. […] Persistent bowel symptoms and rectal lesions led to review of the presentations and repeat biopsy directed toward the edge of the rectal ulcers or from within the polypoid or hyperemic rectal lesions, finally establishing the diagnosis of SRUS.

• #45 Solitary Rectal Ulcer syndrome – WikiLectures

  https://www.wikilectures.eu/w/Solitary_Rectal_Ulcer_syndrome

  Solitary rectal ulcer syndrome is a rare benign clinical entity of not entirely clear etiology. […] The actual diagnosis is based on a combination of the clinical picture, endoscopic findings, and histopathological findings. […] Due to the rarity of the disease, a solitary rectal ulcer is usually not considered and the diagnosis can be made quite a long time from the beginning of the problem. According to published data, the time from the onset of difficulties to diagnosis ranges in a very wide range from three months to thirty years. […] For a correct diagnosis, it is necessary to compare the biopsy not only from the lesion itself but also from the surrounding macroscopically intact mucosa. […] The basic histopathological characteristics are common to all three macroscopic forms.

• #46

  https://link.springer.com/article/10.1007/BF02051170

  Solitary rectal ulcer syndrome (SRUS) often goes unrecognized or is misdiagnosed. Of 98 patients with a final clinicopathologic diagnosis of SRUS, an initially incorrect diagnosis had been made in 25 patients (26 percent). […] In these 25 patients with a misdiagnosis, the median age was 43 years and the female-to-male ratio was 3.21. The median duration of incorrect diagnosis was five years (range, three months to 30 years), and seven patients received prednisone (30 mg/day) for a mistaken diagnosis of inflammatory bowel disease. […] Original rectal biopsy specimens from 23 patients were reviewed; inadequate specimens and failure to recognize diagnostic features of SRUS contributed to delayed diagnosis in 13 and 10 patients, respectively. […] Persistent bowel symptoms and rectal lesions led to review of the presentations and repeat biopsy directed toward the edge of the rectal ulcers or from within the polypoid or hyperemic rectal lesions, finally establishing the diagnosis of SRUS.

• #47 Solitary rectal ulcer syndrome – UpToDate

  https://www.uptodate.com/contents/solitary-rectal-ulcer-syndrome

  Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. […] 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 features, diagnosis, and management of solitary rectal ulcer syndrome. […] A common observation in a number of reports is rectal prolapse or rectal intussusception and paradoxical contraction of the puborectalis muscle. […] A case-control study compared anorectal physiology and defecation proctography in 25 patients with solitary rectal ulcer syndrome with matched controls with either outlet obstruction, overt rectal prolapse without any mucosal change, or overt rectal prolapse with mucosal changes. […] Patients with solitary rectal ulcer syndrome more frequently had increasing anal pressure at straining, paradoxical puborectalis contraction, and prolapse of the inner circular smooth muscle of the rectum and less frequently had complete rectal emptying compared with controls.

• #48 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  In patients with defecation disorders, defecography can detect the functional anorectal components involved in pathogenesis of SRUS. […] Defecation dys-synergy should be diagnosed based on three measures: Presence of constipation, inappropriate pattern of defection on manometry or electromyography, and other evidence of colorectal dysfunction including abnormal defecography, delayed metallic marker elimination or abnormal balloon expulsion test. […] EUS findings in patients with solitary rectal ulcer syndrome include thickening of rectal wall and internal anal sphincter as well as intussusception. […] Typical features of rectal ulcers in SRUS are fibromuscular obliteration in lamina propria along with hypertrophic and disrupted muscularis mucosa and distorted crypt structure. […] It is important to distinguish solitary rectal ulcer syndrome from other disorders which may have similar clinical presentations and endoscopic appearance. The differential diagnosis of SRUS includes rectal cancer, idiopathic inflammatory bowel disease, infectious diseases, rectal endometriosis, and drugs. […] Treatment of SRUS is based on pathophysiology, the severity of symptoms, type of SRUS and presence of rectal prolapse.

• #49 Solitary rectal ulcer syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/diagnosis-treatment/drc-20377754

  You may have one or more of the following tests to diagnose solitary rectal ulcer syndrome: […] During this test, your doctor inserts a thin, flexible tube with a tiny camera into your rectum to examine your rectum and part of your colon. If a lesion is found, your doctor may take a tissue sample for laboratory testing. […] Your doctor may recommend an ultrasound to help differentiate solitary rectal ulcer syndrome from other conditions. […] Your doctor may order an imaging study called defecation proctography. In this study, a soft paste made of barium is inserted into your rectum. […] Specialized centers may offer a similar test called magnetic resonance defecography. This test is done with a magnetic resonance imaging machine and provides a 3D image of the rectum.

• #50

  https://link.springer.com/article/10.1007/BF02555397

  The solitary rectal ulcer and colitis cystica profunda are different manifestations of the solitary rectal ulcer syndrome. […] Since defecation disorders are common among patients with solitary rectal ulcer syndrome, defecography is indicated. […] Defecography is a suitable procedure for detecting the causative disorder of defecation and for selecting patients for treatment.

• #51 Solitary rectal ulcer syndrome – UpToDate

  https://www.uptodate.com/contents/solitary-rectal-ulcer-syndrome

  Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. […] 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 features, diagnosis, and management of solitary rectal ulcer syndrome. […] A common observation in a number of reports is rectal prolapse or rectal intussusception and paradoxical contraction of the puborectalis muscle. […] A case-control study compared anorectal physiology and defecation proctography in 25 patients with solitary rectal ulcer syndrome with matched controls with either outlet obstruction, overt rectal prolapse without any mucosal change, or overt rectal prolapse with mucosal changes. […] Patients with solitary rectal ulcer syndrome more frequently had increasing anal pressure at straining, paradoxical puborectalis contraction, and prolapse of the inner circular smooth muscle of the rectum and less frequently had complete rectal emptying compared with controls.

• #52 Solitary rectal ulcer syndrome – UpToDate

  https://www.uptodate.com/contents/solitary-rectal-ulcer-syndrome/print

  Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. […] This topic will review the pathogenesis, clinical features, diagnosis, and management of solitary rectal ulcer syndrome. […] A case-control study compared anorectal physiology and defecation proctography in 25 patients with solitary rectal ulcer syndrome with matched controls. […] Patients with solitary rectal ulcer syndrome more frequently had increasing anal pressure at straining, paradoxical puborectalis contraction, and prolapse of the inner circular smooth muscle of the rectum and less frequently had complete rectal emptying compared with controls.

• #53 Solitary rectal ulcer syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/diagnosis-treatment/drc-20377754

  You may have one or more of the following tests to diagnose solitary rectal ulcer syndrome: […] During this test, your doctor inserts a thin, flexible tube with a tiny camera into your rectum to examine your rectum and part of your colon. If a lesion is found, your doctor may take a tissue sample for laboratory testing. […] Your doctor may recommend an ultrasound to help differentiate solitary rectal ulcer syndrome from other conditions. […] Your doctor may order an imaging study called defecation proctography. In this study, a soft paste made of barium is inserted into your rectum. […] Specialized centers may offer a similar test called magnetic resonance defecography. This test is done with a magnetic resonance imaging machine and provides a 3D image of the rectum.

• #54 Solitary rectal ulcer syndrome

  https://johnsonmemorial.org/jmh-health-information-library-disease/con-20377737

  You may have one or more of the following tests to diagnose solitary rectal ulcer syndrome: […] During this test, your doctor inserts a thin, flexible tube with a tiny camera into your rectum to examine your rectum and part of your colon. If a lesion is found, your doctor may take a tissue sample for laboratory testing. […] Your doctor may recommend an ultrasound to help differentiate solitary rectal ulcer syndrome from other conditions. […] Your doctor may order an imaging study called defecation proctography. In this study, a soft paste made of barium is inserted into your rectum. You then pass the barium paste as you would stool. The barium shows up on X-rays and may reveal a prolapse or problems with muscle function and muscle coordination. […] Specialized centers may offer a similar test called magnetic resonance defecography. This test is done with a magnetic resonance imaging machine and provides a 3D image of the rectum.

• #55 Solitary Rectal Ulcer Syndrome – Birmingham Pelvic Floor Clinic

  https://birminghampelvicfloorclinic.com/conditions/solitary-rectal-ulcer-syndrome/

  Solitary rectal ulcer syndrome is not very common. Patients have inflammation and thickening in the rectum sometimes this is associated with an internal rectal prolapse (intusseception). […] When you are seen in clinic the consultant will take a full history and carry out a clinical examination. Usually this will involve a rigid sigmoidoscopy and sometimes a proctoscopy as well. […] Most patients will require some form of endoscopic examination of the bowel either by flexible sigmoidoscopy or colonoscopy. Normally a biopsy is taken. […] The most useful test for the enterocele or sigmoidocele itself is a MRI proctogram or a videoproctogram. These tests should confirm the diagnosis and also show any other areas of prolapse such as an rectocele or an enterocele which would require treatment at the same time. […] Most patients will also have tests of their sphincter muscle function (anorectal physiology) and an endoanal ultrasound scan to look for any damage to the muscle.

• #56 Solitary rectal ulcer syndrome and enterocele in a 13-year-old boy

  https://www.termedia.pl/Solitary-rectal-ulcer-syndrome-and-enterocele-in-a-13-year-old-boy,41,21157,1,1.html

  Solitary rectal ulcer syndrome (SRUS) is the term used to describe a wide spectrum of abnormalities affecting mainly young adults with varied clinical presentation, protean endoscopic appearance, yet characteristic histopathological findings. […] Accurate diagnosis and treatment of SRUS still remains a clinical challenge for several reasons. […] A typical histology with the presence of fibromuscular obliteration of the lamina propria and disorientation of muscle fibers is crucial for a diagnosis. […] The pediatric experience with this condition is limited and there is a lack of diagnostic and therapeutic protocols. […] To our knowledge this is the first case of documented enterocele in a pediatric SRUS patient. […] A typical SRUS appears as isolated erythema or a shallow and solitary ulcerating lesion highlighted by erythematous mucosa, usually located on the anterior rectal wall, several centimeters from the anal verge.

• #57 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  In patients with defecation disorders, defecography can detect the functional anorectal components involved in pathogenesis of SRUS. […] Defecation dys-synergy should be diagnosed based on three measures: Presence of constipation, inappropriate pattern of defection on manometry or electromyography, and other evidence of colorectal dysfunction including abnormal defecography, delayed metallic marker elimination or abnormal balloon expulsion test. […] EUS findings in patients with solitary rectal ulcer syndrome include thickening of rectal wall and internal anal sphincter as well as intussusception. […] Typical features of rectal ulcers in SRUS are fibromuscular obliteration in lamina propria along with hypertrophic and disrupted muscularis mucosa and distorted crypt structure. […] It is important to distinguish solitary rectal ulcer syndrome from other disorders which may have similar clinical presentations and endoscopic appearance. The differential diagnosis of SRUS includes rectal cancer, idiopathic inflammatory bowel disease, infectious diseases, rectal endometriosis, and drugs. […] Treatment of SRUS is based on pathophysiology, the severity of symptoms, type of SRUS and presence of rectal prolapse.

• #58 Solitary Rectal Ulcer Syndrome – Birmingham Pelvic Floor Clinic

  https://birminghampelvicfloorclinic.com/conditions/solitary-rectal-ulcer-syndrome/

  Solitary rectal ulcer syndrome is not very common. Patients have inflammation and thickening in the rectum sometimes this is associated with an internal rectal prolapse (intusseception). […] When you are seen in clinic the consultant will take a full history and carry out a clinical examination. Usually this will involve a rigid sigmoidoscopy and sometimes a proctoscopy as well. […] Most patients will require some form of endoscopic examination of the bowel either by flexible sigmoidoscopy or colonoscopy. Normally a biopsy is taken. […] The most useful test for the enterocele or sigmoidocele itself is a MRI proctogram or a videoproctogram. These tests should confirm the diagnosis and also show any other areas of prolapse such as an rectocele or an enterocele which would require treatment at the same time. […] Most patients will also have tests of their sphincter muscle function (anorectal physiology) and an endoanal ultrasound scan to look for any damage to the muscle.

• #59 Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

  https://www.jnmjournal.org/journal/view.html?volume=20&number=4&spage=531

  Using Rome III criteria, most patients with SRUS reported having chronic constipation (36/40 [90%]) in spite of having normal (Bristol stool type IV, 21/40 [53%]) and diarrheal (types V, VI, VII, 6/40 [20%]) stool forms (Asian classification). […] SRUS patients more often (17/40 [43%]) had functional defecation disorder (Rome III criteria). […] FED was commoner among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal sphincter on EUS than those without. […] Seventeen of 40 (42.5%) patients with SRUS fulfilled the Rome III criteria for functional defecation disorder (chronic constipation and abnormalities in 2 physiological test parameters). […] The present study showed that, patients with SRUS (1) more often had chronic constipation by the Rome III criteria, (2) had FED as compared to HC as documented by BET and impaired anal relaxation, (3) more than half of patients with SRU had abnormal defecography, (4) about 40% of the patients with SRU had functional defecation disorders according to the Rome III criteria and (5) those with abnormal BET had thicker IAS than those without. […] We found that a large proportion of patients with SRU had underlying FED and those with FED had thicker IAS. However, whether FED and increased IAS thickness are causes or effects of SRUS is not known.

• #60 Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm14030

  Seventeen of 40 (42.5%) patients with SRUS fulfilled the Rome III criteria for functional defecation disorder (chronic constipation and abnormalities in 2 physiological test parameters). […] The present study showed that, patients with SRUS (1) more often had chronic constipation by the Rome III criteria, (2) had FED as compared to HC as documented by BET and impaired anal relaxation, (3) more than half of patients with SRU had abnormal defecography, (4) about 40% of the patients with SRU had functional defecation disorders according to the Rome III criteria and (5) those with abnormal BET had thicker IAS than those without.

• #61 Solitary Rectal Ulcer Syndrome Mimicking Rectal Cancer

  http://e-emj.org/journal/view.php?number=1291

  Solitary rectal ulcer syndrome (SRUS) is a rare benign and chronic rectal disease that has a wide spectrum of clinical presentations and variable endoscopic findings. It is usually diagnosed by histopathological examination through biopsy. […] SRUS mimicking rectal cancer according to endoscopic findings, abdominopelvic computed tomography (CT), positron emission tomography (PET)-CT, and magnetic resonance imaging (MRI) has been very rarely reported. […] Histopathological examination is a key to the diagnosis of SRUS. Diagnosis of SRUS is by rule-out of other diseases, ultimately through biopsy. Radiologic examination can be done such as abdominopelvic CT or MRI. However, accurate diagnosis is not always possible, and the treatment is still not established. […] Therefore, it is necessary to distinguish carefully for malignancy. Repetitive biopsies are strongly recommended.

• #62 Rectal Ulcer: Symptoms, Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/rectal-ulcer

  In rare cases, rectal ulcers can also develop without an obvious cause if you have a condition called solitary rectal ulcer syndrome (SRUS). SRUS often means youll have rectal ulcers without any other symptoms like pain or changes in your stool. […] A medical professional will usually ask for a medical history and do a physical exam to check your overall health. This may include a digital rectal exam (DRE) to check for signs of injury or disease. […] Imaging tests are often needed to look more closely at the rectum to confirm a diagnosis, including: X-ray, ultrasound, MRI. […] A sigmoidoscopy or colonoscopy may be needed to look further inside your rectum and colon. These tests are done by inserting a thin tube with a light and camera into your rectum to get real-time, detailed images of your rectum. […] A medical professional may also take a tissue sample (biopsy) from your ulcer to test it for infections or cancer.

• #63 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] Colonoscopy and biopsy of normal and abnormal-looking rectal and colonic mucosa should be performed. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] As a result of the wide endoscopic spectrum of SRUS and the fact that the condition may go unrecognized or, more commonly, misdiagnosed, it is crucial to collect biopsy specimens from the involved area to confirm the diagnosis and to exclude other diagnoses, including cancer. […] Anorectal manometry and electromyography provide useful information about anorectal inhibitory reflex, pressure profiles, defecation dynamics, and rectal compliance and sensory thresholds.

• #64 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  In patients with defecation disorders, defecography can detect the functional anorectal components involved in pathogenesis of SRUS. […] Defecation dys-synergy should be diagnosed based on three measures: Presence of constipation, inappropriate pattern of defection on manometry or electromyography, and other evidence of colorectal dysfunction including abnormal defecography, delayed metallic marker elimination or abnormal balloon expulsion test. […] EUS findings in patients with solitary rectal ulcer syndrome include thickening of rectal wall and internal anal sphincter as well as intussusception. […] Typical features of rectal ulcers in SRUS are fibromuscular obliteration in lamina propria along with hypertrophic and disrupted muscularis mucosa and distorted crypt structure. […] It is important to distinguish solitary rectal ulcer syndrome from other disorders which may have similar clinical presentations and endoscopic appearance. The differential diagnosis of SRUS includes rectal cancer, idiopathic inflammatory bowel disease, infectious diseases, rectal endometriosis, and drugs. […] Treatment of SRUS is based on pathophysiology, the severity of symptoms, type of SRUS and presence of rectal prolapse.

• #65 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] Colonoscopy and biopsy of normal and abnormal-looking rectal and colonic mucosa should be performed. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] As a result of the wide endoscopic spectrum of SRUS and the fact that the condition may go unrecognized or, more commonly, misdiagnosed, it is crucial to collect biopsy specimens from the involved area to confirm the diagnosis and to exclude other diagnoses, including cancer. […] Anorectal manometry and electromyography provide useful information about anorectal inhibitory reflex, pressure profiles, defecation dynamics, and rectal compliance and sensory thresholds.

• #66 Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

  https://www.jnmjournal.org/journal/view.html?volume=20&number=4&spage=531

  Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study Atul Sharma, Asha Misra, and Uday C Ghoshal* Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India […] Data on frequency of fecal evacuation disorder (FED) among patients with solitary rectal ulcer syndrome (SRUS), hitherto an enigmatic condition, are scanty. […] Accordingly we undertook a prospective case-control study to evaluate the frequency of fecal evacuation disorder among patients with SRUS compared to healthy control (HC) using anorectal manometry (ARM) and balloon expulsion test (BET). […] Patients with SRUS (26/40 male, age 37 [18?80] years) more often had FED than HC (10/19 male, age 43 [25?72] years) as shown by weight needed to expel the balloon (300 [0?700] g vs. 100 [0?400] g; P = 0.006), a trend towards abnormal BET (need of 200 g weight for expulsion) (21/40 [53%] vs. 5/19 [26%], P = 0.058) and impaired anal relaxation (14/40 [35%] vs 2/19 [10.5%]; P = 0.048).

• #67 Solitary rectal ulcer syndrome – UpToDate

  https://www.uptodate.com/contents/solitary-rectal-ulcer-syndrome

  Solitary rectal ulcer syndrome is an uncommon rectal disorder that can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. […] 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 features, diagnosis, and management of solitary rectal ulcer syndrome. […] A common observation in a number of reports is rectal prolapse or rectal intussusception and paradoxical contraction of the puborectalis muscle. […] A case-control study compared anorectal physiology and defecation proctography in 25 patients with solitary rectal ulcer syndrome with matched controls with either outlet obstruction, overt rectal prolapse without any mucosal change, or overt rectal prolapse with mucosal changes. […] Patients with solitary rectal ulcer syndrome more frequently had increasing anal pressure at straining, paradoxical puborectalis contraction, and prolapse of the inner circular smooth muscle of the rectum and less frequently had complete rectal emptying compared with controls.

• #68 Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

  https://www.jnmjournal.org/journal/view.html?volume=20&number=4&spage=531

  Using Rome III criteria, most patients with SRUS reported having chronic constipation (36/40 [90%]) in spite of having normal (Bristol stool type IV, 21/40 [53%]) and diarrheal (types V, VI, VII, 6/40 [20%]) stool forms (Asian classification). […] SRUS patients more often (17/40 [43%]) had functional defecation disorder (Rome III criteria). […] FED was commoner among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal sphincter on EUS than those without. […] Seventeen of 40 (42.5%) patients with SRUS fulfilled the Rome III criteria for functional defecation disorder (chronic constipation and abnormalities in 2 physiological test parameters). […] The present study showed that, patients with SRUS (1) more often had chronic constipation by the Rome III criteria, (2) had FED as compared to HC as documented by BET and impaired anal relaxation, (3) more than half of patients with SRU had abnormal defecography, (4) about 40% of the patients with SRU had functional defecation disorders according to the Rome III criteria and (5) those with abnormal BET had thicker IAS than those without. […] We found that a large proportion of patients with SRU had underlying FED and those with FED had thicker IAS. However, whether FED and increased IAS thickness are causes or effects of SRUS is not known.

• #69 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  In patients with defecation disorders, defecography can detect the functional anorectal components involved in pathogenesis of SRUS. […] Defecation dys-synergy should be diagnosed based on three measures: Presence of constipation, inappropriate pattern of defection on manometry or electromyography, and other evidence of colorectal dysfunction including abnormal defecography, delayed metallic marker elimination or abnormal balloon expulsion test. […] EUS findings in patients with solitary rectal ulcer syndrome include thickening of rectal wall and internal anal sphincter as well as intussusception. […] Typical features of rectal ulcers in SRUS are fibromuscular obliteration in lamina propria along with hypertrophic and disrupted muscularis mucosa and distorted crypt structure. […] It is important to distinguish solitary rectal ulcer syndrome from other disorders which may have similar clinical presentations and endoscopic appearance. The differential diagnosis of SRUS includes rectal cancer, idiopathic inflammatory bowel disease, infectious diseases, rectal endometriosis, and drugs. […] Treatment of SRUS is based on pathophysiology, the severity of symptoms, type of SRUS and presence of rectal prolapse.

• #70

  https://www.tropicalgastro.com/printerfriendly.aspx?id=1362

  In our study, we found fibromuscular obliteration in all cases and surface ulceration in more than half of the patients. […] The balloon expulsion test was significantly abnormal in SRUS patients compared to that in healthy controls (53% vs. 20%, p 0.01). […] Abnormal anal relaxation was more frequently found in SRUS patients than in controls.

• #71

  https://www.tropicalgastro.com/articles/36/4/solitary-rectal.html

  Key histological features include fibromuscular obliteration of the lamina propria with splaying of muscularis mucosa upward between the crypts, thickened mucosa and glandular distortion. […] In our study, we found fibromuscular obliteration in all cases and surface ulceration in more than half of the patients. […] The balloon expulsion test was significantly abnormal in SRUS patients compared to that in healthy controls (53% vs. 20%, p 0.01). […] Rectal bleeding was the most common symptom and ulcerative lesions the most common endoscopic finding.

• #72 Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm14030

  Patients with SRUS (26/40 male, age 37 [18?80] years) more often had FED than HC (10/19 male, age 43 [25?72] years) as shown by weight needed to expel the balloon (300 [0?700] g vs. 100 [0?400] g; P = 0.006), a trend towards abnormal BET (need of 200 g weight for expulsion) (21/40 [53%] vs. 5/19 [26%], P = 0.058) and impaired anal relaxation (14/40 [35%] vs 2/19 [10.5%]; P = 0.048). […] Using Rome III criteria, most patients with SRUS reported having chronic constipation (36/40 [90%]) in spite of having normal (Bristol stool type IV, 21/40 [53%]) and diarrheal (types V, VI, VII, 6/40 [20%]) stool forms (Asian classification). […] FED was commoner among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal sphincter on EUS than those without.

• #73 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] Colonoscopy and biopsy of normal and abnormal-looking rectal and colonic mucosa should be performed. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] As a result of the wide endoscopic spectrum of SRUS and the fact that the condition may go unrecognized or, more commonly, misdiagnosed, it is crucial to collect biopsy specimens from the involved area to confirm the diagnosis and to exclude other diagnoses, including cancer. […] Anorectal manometry and electromyography provide useful information about anorectal inhibitory reflex, pressure profiles, defecation dynamics, and rectal compliance and sensory thresholds.

• #74 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  In patients with defecation disorders, defecography can detect the functional anorectal components involved in pathogenesis of SRUS. […] Defecation dys-synergy should be diagnosed based on three measures: Presence of constipation, inappropriate pattern of defection on manometry or electromyography, and other evidence of colorectal dysfunction including abnormal defecography, delayed metallic marker elimination or abnormal balloon expulsion test. […] EUS findings in patients with solitary rectal ulcer syndrome include thickening of rectal wall and internal anal sphincter as well as intussusception. […] Typical features of rectal ulcers in SRUS are fibromuscular obliteration in lamina propria along with hypertrophic and disrupted muscularis mucosa and distorted crypt structure. […] It is important to distinguish solitary rectal ulcer syndrome from other disorders which may have similar clinical presentations and endoscopic appearance. The differential diagnosis of SRUS includes rectal cancer, idiopathic inflammatory bowel disease, infectious diseases, rectal endometriosis, and drugs. […] Treatment of SRUS is based on pathophysiology, the severity of symptoms, type of SRUS and presence of rectal prolapse.

• #75 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  In patients with defecation disorders, defecography can detect the functional anorectal components involved in pathogenesis of SRUS. […] Defecation dys-synergy should be diagnosed based on three measures: Presence of constipation, inappropriate pattern of defection on manometry or electromyography, and other evidence of colorectal dysfunction including abnormal defecography, delayed metallic marker elimination or abnormal balloon expulsion test. […] EUS findings in patients with solitary rectal ulcer syndrome include thickening of rectal wall and internal anal sphincter as well as intussusception. […] Typical features of rectal ulcers in SRUS are fibromuscular obliteration in lamina propria along with hypertrophic and disrupted muscularis mucosa and distorted crypt structure. […] It is important to distinguish solitary rectal ulcer syndrome from other disorders which may have similar clinical presentations and endoscopic appearance. The differential diagnosis of SRUS includes rectal cancer, idiopathic inflammatory bowel disease, infectious diseases, rectal endometriosis, and drugs. […] Treatment of SRUS is based on pathophysiology, the severity of symptoms, type of SRUS and presence of rectal prolapse.

• #76 Solitary rectal ulcer syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/symptoms-causes/syc-20377749

  Solitary rectal ulcer syndrome is a rare and poorly understood disorder that often occurs in people with chronic constipation. […] Several other conditions may cause signs and symptoms similar to those of solitary rectal ulcer syndrome. At your appointment, your doctor may recommend tests and procedures to identify or rule out causes other than solitary rectal ulcer syndrome.

• #77 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  In patients with defecation disorders, defecography can detect the functional anorectal components involved in pathogenesis of SRUS. […] Defecation dys-synergy should be diagnosed based on three measures: Presence of constipation, inappropriate pattern of defection on manometry or electromyography, and other evidence of colorectal dysfunction including abnormal defecography, delayed metallic marker elimination or abnormal balloon expulsion test. […] EUS findings in patients with solitary rectal ulcer syndrome include thickening of rectal wall and internal anal sphincter as well as intussusception. […] Typical features of rectal ulcers in SRUS are fibromuscular obliteration in lamina propria along with hypertrophic and disrupted muscularis mucosa and distorted crypt structure. […] It is important to distinguish solitary rectal ulcer syndrome from other disorders which may have similar clinical presentations and endoscopic appearance. The differential diagnosis of SRUS includes rectal cancer, idiopathic inflammatory bowel disease, infectious diseases, rectal endometriosis, and drugs. […] Treatment of SRUS is based on pathophysiology, the severity of symptoms, type of SRUS and presence of rectal prolapse.

• #78 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422/374

  Solitary rectal ulcer syndrome (SRUS) is a benign rectal disease that is rare in pediatric populations due to its underdiagnosis and misdiagnosis in children. […] Diagnosis is made based on clinical symptoms, colonoscopy findings, and histologic finding of fibromuscular obliteration of the lamina propria. […] Inflammatory bowel disease (IBD) and tumors are differentiated from SRUS with histopathology findings: SRUS shows lamina propria scarring and mild inflammatory infiltrate and muscular hyperplasia. […] Although the pathophysiology of SRUS is not well known, it is hypothesized that chronic damage to the mucosa from direct trauma or local ischemia caused by tenesmus, straining during constipation, intussusception of the rectal mucosa, and inflammation from hard stools may play a role.

• #79 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422

  Solitary rectal ulcer syndrome (SRUS) is a benign rectal disease that is rare in pediatric populations due to its underdiagnosis and misdiagnosis in children. […] It is often misdiagnosed as malignancy, Crohns disease, and ulcerative colitis due to its wide and varying clinical presentations. […] Both SRUS and inflammatory bowel disease (IBD) can present with rectal bleeding, constipation, diarrhea, and abdominal pain. […] Furthermore, macroscopic ulcers and inflammation can be seen in both diseases, making it difficult to diagnose without a biopsy. […] These cases emphasize the difficulty and importance of differentiating between IBD and SRUS, and should encourage practitioners to include this differential diagnosis earlier on to improve diagnostic accuracy and begin implementing effective treatment.

• #80

  https://link.springer.com/article/10.1007/BF02051170

  Solitary rectal ulcer syndrome (SRUS) often goes unrecognized or is misdiagnosed. Of 98 patients with a final clinicopathologic diagnosis of SRUS, an initially incorrect diagnosis had been made in 25 patients (26 percent). […] In these 25 patients with a misdiagnosis, the median age was 43 years and the female-to-male ratio was 3.21. The median duration of incorrect diagnosis was five years (range, three months to 30 years), and seven patients received prednisone (30 mg/day) for a mistaken diagnosis of inflammatory bowel disease. […] Original rectal biopsy specimens from 23 patients were reviewed; inadequate specimens and failure to recognize diagnostic features of SRUS contributed to delayed diagnosis in 13 and 10 patients, respectively. […] Persistent bowel symptoms and rectal lesions led to review of the presentations and repeat biopsy directed toward the edge of the rectal ulcers or from within the polypoid or hyperemic rectal lesions, finally establishing the diagnosis of SRUS.

• #81

  https://www.tropicalgastro.com/printerfriendly.aspx?id=1362

  Solitary rectal ulcer syndrome (SRUS) is diagnosed on the basis of clinical symptoms, endoscopic and histological findings. […] The diagnosis of SRUS is based on symptomatology in combination with endoscopic and histologic findings. […] Histopathology is mainspring for the diagnosis of SRUS and also for excluding any other underlying diseases. […] Biopsy is also mandatory in patients with endoscopic evidence of SRUS to rule out malignancy. […] The endoscopic findings in the present study revealed ulcerative lesion in 87% of patients with solitary lesion in only 44 %, hence the term SRUS is misleading. […] The most common diagnostic confusion was with inflammatory bowel disease and neoplastic polyp. […] The histological findings are highly characteristic despite the inconsistency and discrepancy on the clinical and endoscopic findings. Key histological features include fibromuscular obliteration of the lamina propria with splaying of muscularis mucosa upward between the crypts, thickened mucosa and glandular distortion.

• #82 Solitary Rectal Ulcer Syndrome Mimicking Rectal Cancer

  http://e-emj.org/journal/view.php?number=1291

  Solitary rectal ulcer syndrome (SRUS) is a rare benign and chronic rectal disease that has a wide spectrum of clinical presentations and variable endoscopic findings. It is usually diagnosed by histopathological examination through biopsy. […] SRUS mimicking rectal cancer according to endoscopic findings, abdominopelvic computed tomography (CT), positron emission tomography (PET)-CT, and magnetic resonance imaging (MRI) has been very rarely reported. […] Histopathological examination is a key to the diagnosis of SRUS. Diagnosis of SRUS is by rule-out of other diseases, ultimately through biopsy. Radiologic examination can be done such as abdominopelvic CT or MRI. However, accurate diagnosis is not always possible, and the treatment is still not established. […] Therefore, it is necessary to distinguish carefully for malignancy. Repetitive biopsies are strongly recommended.

• #83 Solitary Rectal Ulcer Syndrome Mimicking Rectal Cancer

  http://e-emj.org/journal/view.php?number=1291

  Solitary rectal ulcer syndrome (SRUS) is a rare benign and chronic rectal disease that has a wide spectrum of clinical presentations and variable endoscopic findings. It is usually diagnosed by histopathological examination through biopsy. […] SRUS mimicking rectal cancer according to endoscopic findings, abdominopelvic computed tomography (CT), positron emission tomography (PET)-CT, and magnetic resonance imaging (MRI) has been very rarely reported. […] Histopathological examination is a key to the diagnosis of SRUS. Diagnosis of SRUS is by rule-out of other diseases, ultimately through biopsy. Radiologic examination can be done such as abdominopelvic CT or MRI. However, accurate diagnosis is not always possible, and the treatment is still not established. […] Therefore, it is necessary to distinguish carefully for malignancy. Repetitive biopsies are strongly recommended.

• #84 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  In patients with defecation disorders, defecography can detect the functional anorectal components involved in pathogenesis of SRUS. […] Defecation dys-synergy should be diagnosed based on three measures: Presence of constipation, inappropriate pattern of defection on manometry or electromyography, and other evidence of colorectal dysfunction including abnormal defecography, delayed metallic marker elimination or abnormal balloon expulsion test. […] EUS findings in patients with solitary rectal ulcer syndrome include thickening of rectal wall and internal anal sphincter as well as intussusception. […] Typical features of rectal ulcers in SRUS are fibromuscular obliteration in lamina propria along with hypertrophic and disrupted muscularis mucosa and distorted crypt structure. […] It is important to distinguish solitary rectal ulcer syndrome from other disorders which may have similar clinical presentations and endoscopic appearance. The differential diagnosis of SRUS includes rectal cancer, idiopathic inflammatory bowel disease, infectious diseases, rectal endometriosis, and drugs. […] Treatment of SRUS is based on pathophysiology, the severity of symptoms, type of SRUS and presence of rectal prolapse.

• #85 Solitary Rectal Ulcer Syndrome in Children: A Report of Six Cases

  https://www.gutnliver.org/journal/view.html?volume=7&number=6&spage=752

  Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. […] This syndrome is diagnosed based on clinical symptoms and endoscopic and histological findings, but SRUS often goes unrecognized or is easily confused with other diseases such as inflammatory bowel disease, amoebiasis, malignancy, and other causes of rectal bleeding such as juvenile polyps. […] The diagnosis of the syndrome is based on clinical symptoms and endoscopic and histological findings. […] SRUS should be suspected in patients with rectal discharge of blood and mucus and previous disorders of evacuation. […] Histological examination is the gold standard for establishing the diagnosis of SRUS. […] It is mandatory to take biopsy specimens from the involved area to confirm the diagnosis and to exclude other diseases.

• #86 Solitary Rectal Ulcer Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6819965/

  In patients with defecation disorders, defecography can detect the functional anorectal components involved in pathogenesis of SRUS. […] Defecation dys-synergy should be diagnosed based on three measures: Presence of constipation, inappropriate pattern of defection on manometry or electromyography, and other evidence of colorectal dysfunction including abnormal defecography, delayed metallic marker elimination or abnormal balloon expulsion test. […] EUS findings in patients with solitary rectal ulcer syndrome include thickening of rectal wall and internal anal sphincter as well as intussusception. […] Typical features of rectal ulcers in SRUS are fibromuscular obliteration in lamina propria along with hypertrophic and disrupted muscularis mucosa and distorted crypt structure. […] It is important to distinguish solitary rectal ulcer syndrome from other disorders which may have similar clinical presentations and endoscopic appearance. The differential diagnosis of SRUS includes rectal cancer, idiopathic inflammatory bowel disease, infectious diseases, rectal endometriosis, and drugs. […] Treatment of SRUS is based on pathophysiology, the severity of symptoms, type of SRUS and presence of rectal prolapse.

• #87 Solitary rectal ulcer syndrome: Is it really a rare condition in children?

  https://www.wjgnet.com/2219-2808/full/v5/i3/343.htm

  Solitary rectal ulcer has been defined as an infrequent but benign disorder of rectal and sigmoid region which is diagnosed on the basis of clinical symptom and histologic findings. […] Although solitary rectal ulcer is a relatively common disorder in adults, it has been reported as a rare disease in children, so it can be misdiagnosed and troublesome in pediatric cases. […] The clinical symptoms in children are similar to adults, but since this disorder has not been well known in children, their symptoms can be confused with more common diseases. […] Diagnosis of solitary rectal ulcer is usually based on the clinical history and histopathological changes from the rectal biopsy. […] Before treatment, it is very important to differentiate solitary rectal ulcer from other disorders of the rectum including cancer, Crohns disease, granulomatous diseases like lymphogranuloma venereum using laboratory facilities.

• #88 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] Colonoscopy and biopsy of normal and abnormal-looking rectal and colonic mucosa should be performed. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] As a result of the wide endoscopic spectrum of SRUS and the fact that the condition may go unrecognized or, more commonly, misdiagnosed, it is crucial to collect biopsy specimens from the involved area to confirm the diagnosis and to exclude other diagnoses, including cancer. […] Anorectal manometry and electromyography provide useful information about anorectal inhibitory reflex, pressure profiles, defecation dynamics, and rectal compliance and sensory thresholds.

• #89 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921483/

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. […] Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] It has been recommended that defecography and anorectal manometry should be performed in all children with SRUS to define the primary pathophysiological abnormality and to select the most appropriate treatment protocol. […] The diagnosis can be made clinically, endoscopically, and histologically.

• #90

  https://journals.lww.com/md-journal/fulltext/2018/05040/solitary_rectal_ulcer_syndrome__a_systematic.18.aspx

  Flexible sigmoidoscopy (FS) is a method in which a sigmoidoscope is inserted into the rectum by which the rectum and part of colon can be examined and each diagnostic or therapeutic maneuver is accordingly implemented. […] Medical imaging technique such as magnetic resonance imaging (MRI), defecating proctography, transrectal and endoanal ultrasound, and barium enema have been reported to be most important diagnostic methods for imaging evaluation. […] The diagnosis of SRUS is usually done by analyzing the outcomes of symptoms, endoscopy, sigmoidoscopy, and histology.

• #91 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921483/

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. […] Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] It has been recommended that defecography and anorectal manometry should be performed in all children with SRUS to define the primary pathophysiological abnormality and to select the most appropriate treatment protocol. […] The diagnosis can be made clinically, endoscopically, and histologically.

• #92 Solitary rectal ulcer syndrome – The Midlands Bowel Clinic

  https://themidlandsbowelclinic.com/diagnosis/solitary-rectal-ulcer-syndrome-2/

  Solitary rectal ulcer syndrome (SRUS) is a rare disorder that affects the rectum, leading to the formation of a single or multiple ulcers on the rectal lining. […] To confirm SRUS and rule out other bowel conditions, several diagnostic tests may be performed: […] Flexible sigmoidoscopy or colonoscopy A camera inserted into the rectum to examine the ulcer and surrounding tissue […] Biopsy A small tissue sample is taken from the rectal ulcer to rule out more serious conditions such as inflammatory bowel disease (IBD) or cancer […] Video proctogram or MRI proctogram Specialised imaging tests that assess how the rectum functions during bowel movements and detect issues such as rectal prolapse […] Anorectal physiology tests Used to evaluate pelvic floor function and identify muscle coordination issues.

• #93 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422/374

  Further investigation of symptoms, macroscopic findings and histopathologic reports suggest SRUS as a more accurate diagnosis. […] IBD and malignancy are differentiated from SRUS with histopathology findings. […] The diagnosis of SRUS may require an extensive, holistic and well documented approach supported by both macroscopic and histopathological findings. […] It is important to keep SRUS high on the differential diagnoses when a pediatric patient presents with symptoms with that of IBD, as the treatment of IBD may not be useful for SRUS. […] Furthermore, correctly diagnosing SRUS can decrease the chances of unnecessary surgeries and increase the emotional stability promised by the reassurance of the benign nature of the disease.

• #94 Solitary Rectal Ulcer Syndrome Mimicking Rectal Cancer

  http://e-emj.org/journal/view.php?number=1291

  Solitary rectal ulcer syndrome (SRUS) is a rare benign and chronic rectal disease that has a wide spectrum of clinical presentations and variable endoscopic findings. It is usually diagnosed by histopathological examination through biopsy. […] SRUS mimicking rectal cancer according to endoscopic findings, abdominopelvic computed tomography (CT), positron emission tomography (PET)-CT, and magnetic resonance imaging (MRI) has been very rarely reported. […] Histopathological examination is a key to the diagnosis of SRUS. Diagnosis of SRUS is by rule-out of other diseases, ultimately through biopsy. Radiologic examination can be done such as abdominopelvic CT or MRI. However, accurate diagnosis is not always possible, and the treatment is still not established. […] Therefore, it is necessary to distinguish carefully for malignancy. Repetitive biopsies are strongly recommended.

• #95 Solitary rectal ulcer syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/solitary-rectal-ulcer-syndrome-1?embed_domain=external.radpair.com%2525252527%252525255B0%252525255D%2525252527%252525255B0%252525255D&lang=us

  Solitary rectal ulcer syndrome (SRUS) is a chronic, benign disorder characterized by the presence of an abnormality of the rectum in persons who have a long history of straining during defecation. […] A definitive diagnosis of the syndrome requires a rectal biopsy. […] Diagnosis is delayed in many cases because of its rarity, non-specific presentation and multifactorial nature.

• #96 Solitary rectal ulcer syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Solitary_rectal_ulcer_syndrome

  Solitary rectal ulcer syndrome (SRUS) is a chronic disorder of the rectal mucosa (the lining of the rectum). […] Diagnosis is difficult because of rarity of the condition and because of the variability of the symptoms and the histologic appearance. […] The condition is sometimes misdiagnosed. […] Diagnosis may be delayed by many years as a result. […] Investigations used in the diagnosis of SRUS include defecography, endoanal ultrasound, colonoscopy and histological examination of a biopsy. […] The macroscopic appearance of SRUS is very variable. […] Classically, there is a solitary ulcer. […] The histological appearance is as follows: segmental and superficial (shallow) ulceration. […] This feature differentiates SRUS from inflammatory bowel disease, and is the landmark diagnostic feature for SRUS.

• #97 Solitary rectal ulcer syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/solitary-rectal-ulcer-syndrome-1?embed_domain=external.radpair.com%2525252527%252525255B0%252525255D%2525252527%252525255B0%252525255D&lang=us

  Solitary rectal ulcer syndrome (SRUS) is a chronic, benign disorder characterized by the presence of an abnormality of the rectum in persons who have a long history of straining during defecation. […] A definitive diagnosis of the syndrome requires a rectal biopsy. […] Diagnosis is delayed in many cases because of its rarity, non-specific presentation and multifactorial nature.

• #98 Solitary rectal ulcer syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectal-ulcer/symptoms-causes/syc-20377749

  Solitary rectal ulcer syndrome is a rare and poorly understood disorder that often occurs in people with chronic constipation. […] Several other conditions may cause signs and symptoms similar to those of solitary rectal ulcer syndrome. At your appointment, your doctor may recommend tests and procedures to identify or rule out causes other than solitary rectal ulcer syndrome.

• #99

  https://www.tropicalgastro.com/printerfriendly.aspx?id=1362

  Solitary rectal ulcer syndrome (SRUS) is diagnosed on the basis of clinical symptoms, endoscopic and histological findings. […] The diagnosis of SRUS is based on symptomatology in combination with endoscopic and histologic findings. […] Histopathology is mainspring for the diagnosis of SRUS and also for excluding any other underlying diseases. […] Biopsy is also mandatory in patients with endoscopic evidence of SRUS to rule out malignancy. […] The endoscopic findings in the present study revealed ulcerative lesion in 87% of patients with solitary lesion in only 44 %, hence the term SRUS is misleading. […] The most common diagnostic confusion was with inflammatory bowel disease and neoplastic polyp. […] The histological findings are highly characteristic despite the inconsistency and discrepancy on the clinical and endoscopic findings. Key histological features include fibromuscular obliteration of the lamina propria with splaying of muscularis mucosa upward between the crypts, thickened mucosa and glandular distortion.

• #100 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://www.wjgnet.com/1007-9327/full/v20/i3/738.htm

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. […] The aim of the present review is to summarize the clinical features, pathophysiology, diagnostic methods and treatment strategies associated with SRUS. […] The clinical presentation varies, therefore, early diagnosis requires a high index of suspicion from both the surgeon and the pathologist, especially because the term solitary rectal ulcer is a misnomer and only a quarter of the adults with SRUS have a true rectal ulcer, and the lesion is not necessarily solitary or ulcerated.

• #101

  https://link.springer.com/article/10.1007/BF02051170

  Solitary rectal ulcer syndrome (SRUS) often goes unrecognized or is misdiagnosed. Of 98 patients with a final clinicopathologic diagnosis of SRUS, an initially incorrect diagnosis had been made in 25 patients (26 percent). […] In these 25 patients with a misdiagnosis, the median age was 43 years and the female-to-male ratio was 3.21. The median duration of incorrect diagnosis was five years (range, three months to 30 years), and seven patients received prednisone (30 mg/day) for a mistaken diagnosis of inflammatory bowel disease. […] Original rectal biopsy specimens from 23 patients were reviewed; inadequate specimens and failure to recognize diagnostic features of SRUS contributed to delayed diagnosis in 13 and 10 patients, respectively. […] Persistent bowel symptoms and rectal lesions led to review of the presentations and repeat biopsy directed toward the edge of the rectal ulcers or from within the polypoid or hyperemic rectal lesions, finally establishing the diagnosis of SRUS.

• #102

  https://link.springer.com/article/10.1007/BF02051170

  Solitary rectal ulcer syndrome (SRUS) often goes unrecognized or is misdiagnosed. Of 98 patients with a final clinicopathologic diagnosis of SRUS, an initially incorrect diagnosis had been made in 25 patients (26 percent). […] In these 25 patients with a misdiagnosis, the median age was 43 years and the female-to-male ratio was 3.21. The median duration of incorrect diagnosis was five years (range, three months to 30 years), and seven patients received prednisone (30 mg/day) for a mistaken diagnosis of inflammatory bowel disease. […] Original rectal biopsy specimens from 23 patients were reviewed; inadequate specimens and failure to recognize diagnostic features of SRUS contributed to delayed diagnosis in 13 and 10 patients, respectively. […] Persistent bowel symptoms and rectal lesions led to review of the presentations and repeat biopsy directed toward the edge of the rectal ulcers or from within the polypoid or hyperemic rectal lesions, finally establishing the diagnosis of SRUS.

• #103 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?doi=10.4166/kjg.2023.093

  The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04). […] The time between the onset of symptoms and diagnosis was significantly shorter in patients who showed remission than in those who did not (p=0.04). […] The rate of early diagnosis will increase if the awareness about SRUS in children increases, resulting in early treatment that will allow remission in more patients.

• #104 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?uid=5986&vmd=Full&

  The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04). […] The treatment was started with toilet training, a high-fiber diet, and laxatives. […] The time between the onset of symptoms and diagnosis was significantly shorter in patients who showed remission than in those who did not (p=0.04).

• #105 Solitary rectal ulcer syndrome and enterocele in a 13-year-old boy

  https://www.termedia.pl/Solitary-rectal-ulcer-syndrome-and-enterocele-in-a-13-year-old-boy,41,21157,1,1.html

  The treatment of SRUS remains problematic and several options have been used in the management of SRUS, ranging from behavioral modification to topical treatment, biofeedback and surgery. […] Because the clinical and macroscopic presentation varies, an early diagnosis requires a high index of suspicion both for the clinician and for the pathologist to consider SRUS in differential diagnosis.

• #106 Solitary Rectal Ulcer Syndrome Is Not Always Ulcerated: A Case Report

  https://www.mdpi.com/1648-9144/58/8/1136

  Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults that is characterized by a series of symptoms such as rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, a feeling of incomplete defecation, constipation and, rarely, rectal prolapse. […] The etiology of this syndrome remains obscure, and the diagnosis is easily confused with that of other diseases, contributing to difficulties in treatment. […] The diagnosis of SRUS can usually be performed by a combination of symptomatology, endoscopy and histology. […] However, patients sometimes have typical symptoms without typical endoscopic findings. […] Not all SRUS cases present ulcers. Patients with typical symptoms and nonulcerated rectal lesions should be differentiated from those with superficial rectal cancer. Magnifying NBI and chromoendoscopy are useful, and histopathological examination should be performed to confirm the diagnosis.

• #107 Coexistence of Solitary Rectal Ulcer Syndrome and Ulcerative Colitis: A Case Report and Literature Review

  https://www.irjournal.org/journal/view.php?doi=10.5217/ir.2014.12.1.70

  SRUS accompanied by IBD is extremely rare, and an accurate differential diagnosis is difficult to achieve. […] The patient was finally diagnosed with coexistence of SRUS and UC. […] The characteristic histological findings in all three cases were fibromuscular obliteration of the lamina propria, thickening of the muscularis mucosa, and elongation and distortion of the crypt. […] In conclusion, although coexistence of SRUS and UC is extremely rare, we suggest that the association between SRUS and UC may not be fortuitous.

• #108 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422/374

  Further investigation of symptoms, macroscopic findings and histopathologic reports suggest SRUS as a more accurate diagnosis. […] IBD and malignancy are differentiated from SRUS with histopathology findings. […] The diagnosis of SRUS may require an extensive, holistic and well documented approach supported by both macroscopic and histopathological findings. […] It is important to keep SRUS high on the differential diagnoses when a pediatric patient presents with symptoms with that of IBD, as the treatment of IBD may not be useful for SRUS. […] Furthermore, correctly diagnosing SRUS can decrease the chances of unnecessary surgeries and increase the emotional stability promised by the reassurance of the benign nature of the disease.

• #109 Solitary Rectal Ulcer Syndrome – A Rare Entity in the Pediatric Population – Turkish Journal of Pathology

  https://turkjpath.org/text.php?id=2082

  The treatment protocol involves conservative management that includes patient education and behavioral modification as the first step, followed by a high-fiber diet and bulking laxatives, followed by topical treatments with salicylate, sulfasalazine, steroids, sucralfate, and lastly surgery. […] Timely and correct diagnosis reduces the morbidity associated with this entity.

• #110 Solitary Rectal Ulcer Syndrome – Birmingham Pelvic Floor Clinic

  https://birminghampelvicfloorclinic.com/conditions/solitary-rectal-ulcer-syndrome/

  Solitary rectal ulcer syndrome is not very common. Patients have inflammation and thickening in the rectum sometimes this is associated with an internal rectal prolapse (intusseception). […] When you are seen in clinic the consultant will take a full history and carry out a clinical examination. Usually this will involve a rigid sigmoidoscopy and sometimes a proctoscopy as well. […] Most patients will require some form of endoscopic examination of the bowel either by flexible sigmoidoscopy or colonoscopy. Normally a biopsy is taken. […] The most useful test for the enterocele or sigmoidocele itself is a MRI proctogram or a videoproctogram. These tests should confirm the diagnosis and also show any other areas of prolapse such as an rectocele or an enterocele which would require treatment at the same time. […] Most patients will also have tests of their sphincter muscle function (anorectal physiology) and an endoanal ultrasound scan to look for any damage to the muscle.

• #111 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422

  Solitary rectal ulcer syndrome (SRUS) is a benign rectal disease that is rare in pediatric populations due to its underdiagnosis and misdiagnosis in children. […] It is often misdiagnosed as malignancy, Crohns disease, and ulcerative colitis due to its wide and varying clinical presentations. […] Both SRUS and inflammatory bowel disease (IBD) can present with rectal bleeding, constipation, diarrhea, and abdominal pain. […] Furthermore, macroscopic ulcers and inflammation can be seen in both diseases, making it difficult to diagnose without a biopsy. […] These cases emphasize the difficulty and importance of differentiating between IBD and SRUS, and should encourage practitioners to include this differential diagnosis earlier on to improve diagnostic accuracy and begin implementing effective treatment.

• #112 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?uid=5986&vmd=Full&

  Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. […] The diagnosis can be difficult because the endoscopic and histopathological findings of SRUS may mimic other disorders of the rectum. […] The diagnosis is based on the clinical findings, detection of an ulcer on the anterior wall of the rectum by colonoscopy, and characteristic histopathological changes. […] The treatment includes correcting the pathogenic mechanisms by softening the stool through behavioral changes (to avoid staying on the toilet for a long time, not straining for a long time, and using a squat toilet or putting a step under the feet if the feet do not reach the floor when using a European toilet), bowel training, and the use of laxatives. […] Because patients are admitted with a variety of clinical presentations, both clinicians and pathologists should be highly aware of SRUS.

• #113 Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921483/

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. […] Diagnosis of SRUS is based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry and electromyography. […] A complete and thorough history is most important in the initial diagnosis of SRUS. […] The appearance of SRUS on endoscopy may vary from preulcer hyperemic changes of rectal mucosa to established ulcers covered by a white, grey or yellowish slough. […] It has been recommended that defecography and anorectal manometry should be performed in all children with SRUS to define the primary pathophysiological abnormality and to select the most appropriate treatment protocol. […] The diagnosis can be made clinically, endoscopically, and histologically.

• #114 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?uid=5986&vmd=Full&

  Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. […] The diagnosis can be difficult because the endoscopic and histopathological findings of SRUS may mimic other disorders of the rectum. […] The diagnosis is based on the clinical findings, detection of an ulcer on the anterior wall of the rectum by colonoscopy, and characteristic histopathological changes. […] The treatment includes correcting the pathogenic mechanisms by softening the stool through behavioral changes (to avoid staying on the toilet for a long time, not straining for a long time, and using a squat toilet or putting a step under the feet if the feet do not reach the floor when using a European toilet), bowel training, and the use of laxatives. […] Because patients are admitted with a variety of clinical presentations, both clinicians and pathologists should be highly aware of SRUS.

• #115 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?doi=10.4166/kjg.2023.093

  The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04). […] The time between the onset of symptoms and diagnosis was significantly shorter in patients who showed remission than in those who did not (p=0.04). […] The rate of early diagnosis will increase if the awareness about SRUS in children increases, resulting in early treatment that will allow remission in more patients.

• #116 Solitary Rectal Ulcer Syndrome – A Rare Entity in the Pediatric Population – Turkish Journal of Pathology

  https://turkjpath.org/text.php?id=2082

  The treatment protocol involves conservative management that includes patient education and behavioral modification as the first step, followed by a high-fiber diet and bulking laxatives, followed by topical treatments with salicylate, sulfasalazine, steroids, sucralfate, and lastly surgery. […] Timely and correct diagnosis reduces the morbidity associated with this entity.

• #117 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?doi=10.4166/kjg.2023.093

  The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04). […] The time between the onset of symptoms and diagnosis was significantly shorter in patients who showed remission than in those who did not (p=0.04). […] The rate of early diagnosis will increase if the awareness about SRUS in children increases, resulting in early treatment that will allow remission in more patients.

• #118

  https://link.springer.com/article/10.1007/BF02051170

  Solitary rectal ulcer syndrome (SRUS) often goes unrecognized or is misdiagnosed. Of 98 patients with a final clinicopathologic diagnosis of SRUS, an initially incorrect diagnosis had been made in 25 patients (26 percent). […] In these 25 patients with a misdiagnosis, the median age was 43 years and the female-to-male ratio was 3.21. The median duration of incorrect diagnosis was five years (range, three months to 30 years), and seven patients received prednisone (30 mg/day) for a mistaken diagnosis of inflammatory bowel disease. […] Original rectal biopsy specimens from 23 patients were reviewed; inadequate specimens and failure to recognize diagnostic features of SRUS contributed to delayed diagnosis in 13 and 10 patients, respectively. […] Persistent bowel symptoms and rectal lesions led to review of the presentations and repeat biopsy directed toward the edge of the rectal ulcers or from within the polypoid or hyperemic rectal lesions, finally establishing the diagnosis of SRUS.

• #119 Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population | Tung | International Journal of Clinical Pediatrics

  https://www.theijcp.org/index.php/ijcp/article/view/422/374

  Further investigation of symptoms, macroscopic findings and histopathologic reports suggest SRUS as a more accurate diagnosis. […] IBD and malignancy are differentiated from SRUS with histopathology findings. […] The diagnosis of SRUS may require an extensive, holistic and well documented approach supported by both macroscopic and histopathological findings. […] It is important to keep SRUS high on the differential diagnoses when a pediatric patient presents with symptoms with that of IBD, as the treatment of IBD may not be useful for SRUS. […] Furthermore, correctly diagnosing SRUS can decrease the chances of unnecessary surgeries and increase the emotional stability promised by the reassurance of the benign nature of the disease.

• #120

  https://www.omjournal.org/articleDetails.aspx?coType=1&aId=160

  Treatment initially consists of conservative management, including an increase in dietary fiber, bowel retraining, and bulk laxatives. If conservative management fails, surgery, in the form of transrectal resection, is indicated. […] Our findings indicate that solitary rectal ulcer syndrome is not such a rare condition in children. Physicians should be aware of its incidence in children to avoid missing or delaying its diagnosis. Treatment is initially conservative, but, if that fails, transrectal resection followed by a high-fiber diet is usually curative.

• #121 Long term conservative approach in a young male with solitary rectal ulcer syndrome – MedCrave online

  https://medcraveonline.com/MOJCR/long-term-conservative-approach-in-a-young-male-with-solitary-rectal-ulcer-syndrome.html

  The solitary rectal ulcer syndrome is a rare entity commonly occurring in young patients. […] Diagnosis can be made by clinical suspicion only. Endoscopic appearance is variable so biopsy should always be taken for confirmation of diagnosis. […] To detect the causative disorder in solitary rectal ulcer syndrome; defecography, transrectal ultrasonography or anorectal manometery are the appropriate investigations. […] The endoscopic picture of a bleeding SRUS is difficult to differentiate from other causes of rectal bleeding. […] The histopathology shows chronic inflammatory cells and fibroblasts in the lamina propria often associated with smooth muscle hypertrophy. […] The treatment of SRUS remains unclear and varies from conservative management to operative treatment. […] The aim of treatment is to cure the symptoms and achieve complete healing of ulcer.

• #122 Solitary rectal ulcer syndrome and enterocele in a 13-year-old boy

  https://www.termedia.pl/Solitary-rectal-ulcer-syndrome-and-enterocele-in-a-13-year-old-boy,41,21157,1,1.html

  The treatment of SRUS remains problematic and several options have been used in the management of SRUS, ranging from behavioral modification to topical treatment, biofeedback and surgery. […] Because the clinical and macroscopic presentation varies, an early diagnosis requires a high index of suspicion both for the clinician and for the pathologist to consider SRUS in differential diagnosis.

• #123 Solitary rectal ulcer syndrome: Is it really a rare condition in children?

  https://www.wjgnet.com/2219-2808/full/v5/i3/343.htm

  The aim of this study was to assess the children diagnosed with solitary rectal ulcer in Southern Iran. […] The diagnosis of solitary rectal ulcer in our patients was based on the clinical history, colonoscopic and histopathological findings of rectosigmoid biopsies. […] In this study, 55 children with the final diagnosis of solitary rectal ulcer were evaluated in 11 years, and to the best of our knowledge it is the largest pediatric series in the world. […] According to this study and other related studies, it seems that rectal bleeding is the most common symptom; other less common symptoms were mucorrhea and straining during defecation which can be easily obtained from the patients history. […] Therefore, the physicians should be aware of this disorder and thus prevent the late diagnosis of the disease and prevent its long term complications.

• #124 Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

  https://www.kjg.or.kr/journal/view.html?uid=5986&vmd=Full&

  The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04). […] The treatment was started with toilet training, a high-fiber diet, and laxatives. […] The time between the onset of symptoms and diagnosis was significantly shorter in patients who showed remission than in those who did not (p=0.04).

• #125 Solitary Rectal Ulcer Syndrome – A Rare Entity in the Pediatric Population – Turkish Journal of Pathology

  https://turkjpath.org/text.php?id=2082

  The treatment protocol involves conservative management that includes patient education and behavioral modification as the first step, followed by a high-fiber diet and bulking laxatives, followed by topical treatments with salicylate, sulfasalazine, steroids, sucralfate, and lastly surgery. […] Timely and correct diagnosis reduces the morbidity associated with this entity.

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