Materiały źródłowe

• #1 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. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse.

• #2 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. […] The incidence of solitary rectal ulcer syndrome is uncertain but has been estimated in one study to be 1 in 100,000 individuals per year. […] In one retrospective study of 80 patients, the median age at diagnosis was 48 years with a range of 14 to 76 years. […] Males and females appear to be affected equally, but a slight female preponderance has been suggested in some reports of adults. […] By contrast, in a series of 140 children, the majority (79 percent) were boys.

• #3 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. […] Its exact prevalence is not clearly known but a figure of 1:100,000 per year is usually reported and there seems to be no sexual or age preference. […] 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. […] 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.

• #4 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 a rare benign disorder characterized by a combination of symptoms, endoscopic findings, and histological abnormalities. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. […] The cause of SRUS is unknown. […] 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.

• #5

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

  Solitary rectal ulcer syndrome (SRUS) is an unusual rectal disorder that does not necessarily end with an ulcer and may affect different parts of the rectum and other site of gastrointestinal tract. […] The prevalence of SRUS is not exactly clear, but it is estimated as 1 in 100,000 people per year. […] A large number of SRUS patients have been reported from a specialized gastroenterology center in Iran over the past 5 years, indicating a high prevalence in Iran. […] 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. […] 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.

• #6 Solitary rectal ulcer syndrome – Wikipedia

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

  The condition is relatively rare, but the exact prevalence is not known. Prevalence has been estimated as 1 in 100,000 people per year. SRUS can occur at any age, but it is most common in adults aged between 30-50. Males and females are affected almost equally, or females slightly more. […] Misdiagnosis as inflammatory bowel disease (IBD) or rectal polyps may hide the true prevalence of SRUS.

• #7 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. […] The incidence of solitary rectal ulcer syndrome is uncertain but has been estimated in one study to be 1 in 100,000 individuals per year. […] In one retrospective study of 80 patients, the median age at diagnosis was 48 years with a range of 14 to 76 years. […] Males and females appear to be affected equally, but a slight female preponderance has been suggested in some reports of adults. […] By contrast, in a series of 140 children, the majority (79 percent) were boys.

• #8 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. […] A total of 116 patients were evaluated. The mean age was 37.416.6 (range: 1380) years, 61 (53%) of the patients were male. […] Endoscopically, solitary and multiple lesions were present in 79 (68%) and 33 (28%) patients respectively; ulcerative lesions in 90 (78%), polypoidal in 29 (25%), erythematous patches in 3 (2.5%) and petechial spots in one patient. […] Associated underlying conditions were hemorrhoids in 7 (6%), hyperplastic polyps in 4 (3.5%), adenomatous polyps in 2(2%), history of ulcerative colitis in 3 (2.5%) while adenocarcinoma of colon was observed in two patients.

• #9 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 rare benign rectal disease that is characterized by a combination of symptoms, clinical findings and histological abnormalities. However, SRUS is an infrequent disease that is easily underdiagnosed, with an estimated annual prevalence of one in 100,000 persons. It occurs most commonly in the third decade in men and in the fourth decade in women. […] SRUS is easily misdiagnosed as rectal cancer, based on the similarity in the symptomatic profiles and endoscopic features, which include bleeding, mucus discharge, and chronic and severe constipation. To date, these histological features have been helpful in distinguishing SRUS from malignancies. […] 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.

• #10 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 a rare benign disorder characterized by a combination of symptoms, endoscopic findings, and histological abnormalities. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. […] The cause of SRUS is unknown. […] 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.

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

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

  Solitary rectal ulcer syndrome is rare. It occurs in about 1 out of every 100,000 people. Most people who get this diagnosis are in their 30s or 40s, but it also affects children and older adults. […] Up to 25% of people with solitary rectal ulcer syndrome dont have symptoms. […] It isnt always possible to prevent rectal ulcers. You can reduce your risk, though, by trying to keep your bowel movements regular so youre not straining at the toilet and damaging rectal tissue. Staying hydrated, eating high-fiber foods and trying stool softeners can help.

• #12 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. […] It is a rare entity with an incidence of 1/100000 population/year, more common in young adults aged between 20 and 35 years, especially in females. Presentation in childhood or adolescence is exceptional, with only isolated case series having been reported. […] Clinically, it manifests with rectal bleeding, which is usually mild, often accompanied by mucus, as well as tenesmus, straining, feeling of incomplete evacuation, abdominal pain, proctalgia and, occasionally, defaecation urgency. […] 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.

• #13 Solitary rectal ulcer syndrome presenting as polypoid mass lesions in a young girl

  https://www.wjgnet.com/1948-5204/full/v2/i8/332.htm

  Solitary rectal ulcer syndrome (SRUS) is a rare benign disease of the rectum, which predominately affects young adults aged between 30 and 50 years with a prevalence of 1 in 100000 people per year. […] SRUS is rare in children and its description is largely limited to case reports. […] The clinical presentation of SRUS is diverse. Patients commonly present with obstructed defecation, rectal bleeding or prolapsed rectal mucosa either overt or occult. […] In adults, 25%-32% of SRUS may appear as polypoid lesions. […] Among the cases reported in children, the polypoid variant is very rare and has previously been reported in only two patients. […] Rectal prolapse is associated with 16%-59% of SRUS in adults. […] Therapeutic experience in children with SRUS is limited, with widely varying reported treatment protocols and poorly documented clinical outcomes. […] In conclusion, the presence of a rectal polypoid mass with ulceration in a child with obstructed defecation and rectal bleeding should raise the suspicion of SRUS.

• #14 Solitary Rectal Ulcer Syndrome: An Exceptional Entity in the Elderly | Auctores

  https://auctoresonline.org/article/solitary-rectal-ulcer-syndrome-an-exceptional-entity-in-the-elderly

  Solitary ulcer of the rectum or better the syndrome of solitary rectal ulcer syndrome (SRUS) is a rare benign pathology with a prevalence estimated at 1/100,000 inhabitants. […] It remains exceptional in the elderly with only few sporadic cases in the world literature. […] The SRUS is a disease of young adults with a maximum incidence between the third and fourth decade of life. […] The forms of the child and the elderly remain exceptional. […] It remains exceptional in the elderly with only few sporadic cases in the world literature. […] As rare as it is, this entity deserves to be known by any healthcare professional caring for elderly subjects because can sometimes progress unfavorably with severe and even fatal complications such as massive bleeding and perforation. […] Its pathogenesis is still uncertain.

• #15 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. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse.

• #16 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 a rare benign disorder characterized by a combination of symptoms, endoscopic findings, and histological abnormalities. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. […] The cause of SRUS is unknown. […] 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.

• #17 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. […] The incidence of solitary rectal ulcer syndrome is uncertain but has been estimated in one study to be 1 in 100,000 individuals per year. […] In one retrospective study of 80 patients, the median age at diagnosis was 48 years with a range of 14 to 76 years. […] Males and females appear to be affected equally, but a slight female preponderance has been suggested in some reports of adults. […] By contrast, in a series of 140 children, the majority (79 percent) were boys.

• #18 Solitary rectal ulcer syndrome – Wikipedia

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

  The condition is relatively rare, but the exact prevalence is not known. Prevalence has been estimated as 1 in 100,000 people per year. SRUS can occur at any age, but it is most common in adults aged between 30-50. Males and females are affected almost equally, or females slightly more. […] Misdiagnosis as inflammatory bowel disease (IBD) or rectal polyps may hide the true prevalence of SRUS.

• #19 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

  Only 35% of cases have a solitary ulcer of the rectal wall. 22% have multiple ulcers. 43% have no ulcers at all. It typically occurs in young adults, with a slightly increased female predilection. […] 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.

• #20 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. […] The incidence of solitary rectal ulcer syndrome is uncertain but has been estimated in one study to be 1 in 100,000 individuals per year. […] In one retrospective study of 80 patients, the median age at diagnosis was 48 years with a range of 14 to 76 years. […] Males and females appear to be affected equally, but a slight female preponderance has been suggested in some reports of adults. […] By contrast, in a series of 140 children, the majority (79 percent) were boys.

• #21 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 average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years). It has been reported that 75% to 80% of children with SRUS are boys as similar with our report. […] The pathophysiology of SRUS is incompletely understood. It is supposed to be due to secondary to ischemia and trauma to the rectal mucosa and paradoxical contraction of pelvic floor. The excessive straining generates a high intrarectal pressure which pushes the anterior rectal mucosa into the contracting puborectalis muscle resulting in pressure necrosis of rectal mucosa and the anterior rectal mucosa is frequently forced into the closed anal canal causing congestion, edema, and ulceration. […] 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.

• #22 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

  Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. […] The prevalence of SRUS is one per 100,000 person-years in children. […] Approximately 75-80% of the patients are males. […] The low prevalence of SRUS in children has been suggested to be because it is often unrecognized or misdiagnosed. […] The diagnosis can be difficult because the endoscopic and histopathological findings of SRUS may mimic other disorders of the rectum. […] This study is the first large series on Turkish children. […] An increased awareness of SRUS in children will increase the rate of early diagnosis and treatment, allowing remission in more patients. […] The median time to diagnosis was 24 months. […] The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04).

• #23 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. […] This study included patients diagnosed with SRUS between January 2020 and January 2024. […] A total of 36 patients diagnosed with SRUS were included, with the majority being male (80.6%), and the mean age of participants was 75.6 years. […] Hematochezia was identified as the most common initial symptom (61.1%), followed by abdominal pain (16.7%) and constipation (11.1%). […] This study offers a comprehensive analysis of SRUS, emphasizing the importance of detailed clinical and laboratory evaluation. […] 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.

• #24 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. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse.

• #25 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 a rare benign disorder characterized by a combination of symptoms, endoscopic findings, and histological abnormalities. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. […] The cause of SRUS is unknown. […] 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.

• #26 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 average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years). It has been reported that 75% to 80% of children with SRUS are boys as similar with our report. […] The pathophysiology of SRUS is incompletely understood. It is supposed to be due to secondary to ischemia and trauma to the rectal mucosa and paradoxical contraction of pelvic floor. The excessive straining generates a high intrarectal pressure which pushes the anterior rectal mucosa into the contracting puborectalis muscle resulting in pressure necrosis of rectal mucosa and the anterior rectal mucosa is frequently forced into the closed anal canal causing congestion, edema, and ulceration. […] 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.

• #27 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 a rare benign disorder characterized by a combination of symptoms, endoscopic findings, and histological abnormalities. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. […] The cause of SRUS is unknown. […] 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.

• #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. […] Its exact prevalence is not clearly known but a figure of 1:100,000 per year is usually reported and there seems to be no sexual or age preference. […] 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. […] 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.

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

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

  The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. […] 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. […] In a quarter of patients, a delay in diagnosis or misdiagnosis of SRUS might occur because of inadequate rectal biopsy and failure to recognize the histopathological features of the disease. […] Several treatment options have been used for SRUS, ranging from conservative treatment (i.e., diet and bulking agents), medical therapy, biofeedback and surgery. […] The choice of treatment depends upon the severity of symptoms and whether there is a rectal prolapse.

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

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

  In a quarter of patients, a delay in diagnosis or misdiagnosis of SRUS might occur because of inadequate rectal biopsy and failure to recognize the histopathological features of the disease. […] 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. […] Several treatment options have been used for SRUS, ranging from conservative treatment (i.e., diet and bulking agents), medical therapy, biofeedback and surgery. […] The choice of treatment depends upon the severity of symptoms and whether there is a rectal prolapse. […] Patient education and behavioral modification are the first steps in the treatment of SRUS. […] However, it would appear that conservative approaches are less useful when SRUS is associated with an advanced grade of rectal intussusception, extensive inflammation, established fibrosis and/or reducible external prolapse. […] Surgery remains an option for patients not responsive to conservative measures and biofeedback. […] The evidence regarding which approach is first-line for SRUS is unclear.

• #31 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

  Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. […] The prevalence of SRUS is one per 100,000 person-years in children. […] Approximately 75-80% of the patients are males. […] The low prevalence of SRUS in children has been suggested to be because it is often unrecognized or misdiagnosed. […] The diagnosis can be difficult because the endoscopic and histopathological findings of SRUS may mimic other disorders of the rectum. […] This study is the first large series on Turkish children. […] An increased awareness of SRUS in children will increase the rate of early diagnosis and treatment, allowing remission in more patients. […] The median time to diagnosis was 24 months. […] The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04).

• #32 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

  Increasing the awareness of this condition will result in the identification of more cases in Trkiye. […] The treatment of SRUS varies according to the severity of symptoms. […] 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).

• #33 Solitary Rectal Ulcer syndrome – WikiLectures

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

  The frequency of the disease is estimated to be 1 per 100,000 inhabitants, but it will probably be higher due to underdiagnosis. It usually occurs in young adults but has also been described in children and the elderly. Disabilities of both sexes are about the same, with a probably insignificant predominance of disabilities in women. […] 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.

• #34 Solitary rectal ulcer syndrome – Wikipedia

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

  The condition is relatively rare, but the exact prevalence is not known. Prevalence has been estimated as 1 in 100,000 people per year. SRUS can occur at any age, but it is most common in adults aged between 30-50. Males and females are affected almost equally, or females slightly more. […] Misdiagnosis as inflammatory bowel disease (IBD) or rectal polyps may hide the true prevalence of SRUS.

• #35

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

  Solitary rectal ulcer syndrome (SRUS) is an unusual rectal disorder that does not necessarily end with an ulcer and may affect different parts of the rectum and other site of gastrointestinal tract. […] The prevalence of SRUS is not exactly clear, but it is estimated as 1 in 100,000 people per year. […] A large number of SRUS patients have been reported from a specialized gastroenterology center in Iran over the past 5 years, indicating a high prevalence in Iran. […] 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. […] 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: Symptoms, Tests & Treatment

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

  Solitary rectal ulcer syndrome is rare. It occurs in about 1 out of every 100,000 people. Most people who get this diagnosis are in their 30s or 40s, but it also affects children and older adults. […] Up to 25% of people with solitary rectal ulcer syndrome dont have symptoms. […] It isnt always possible to prevent rectal ulcers. You can reduce your risk, though, by trying to keep your bowel movements regular so youre not straining at the toilet and damaging rectal tissue. Staying hydrated, eating high-fiber foods and trying stool softeners can help.

• #37 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. […] A total of 116 patients were evaluated. The mean age was 37.416.6 (range: 1380) years, 61 (53%) of the patients were male. […] Endoscopically, solitary and multiple lesions were present in 79 (68%) and 33 (28%) patients respectively; ulcerative lesions in 90 (78%), polypoidal in 29 (25%), erythematous patches in 3 (2.5%) and petechial spots in one patient. […] Associated underlying conditions were hemorrhoids in 7 (6%), hyperplastic polyps in 4 (3.5%), adenomatous polyps in 2(2%), history of ulcerative colitis in 3 (2.5%) while adenocarcinoma of colon was observed in two patients.

• #38 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

  Associated underlying conditions were hemorrhoids in 7 (6%) (Figure1), hyperplastic polyps in 4 (3.5%), adenomatous polyps in 2 (2%) and adenocarcinoma of colon in two patients (Figure6) while 3 patients had history of ulcerative colitis. […] The findings in the present series correspond with the literature in terming SRUS as a misnomer. […] Histopathological analysis forms the cornerstone of diagnosing SRUS and is a requisite to rule out any other underlying disease. […] Inconsistency in morphologic appearances of associated lesions increases the likelihood of delayed or erroneous diagnosis of SRUS. […] Present study reveals that the rectal bleeding, abdominal pain and constipation were the most common symptoms encountered in patients with SRUS. […] A high index of suspicion is therefore required to diagnose potentially serious disease by repeated examinations and biopsies for histopathology.

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

  https://www.irjournal.org/journal/view.php?number=54

  Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease that is misdiagnosed as malignancy or inflammatory bowel disease because of similarities in clinical and endoscopic manifestations. […] SRUS with ulcerative colitis (UC) is extremely rare. To date, two cases have been reported in the medical literature. […] SRUS is diagnosed by a combination of clinical aspects, endoscopic presentations, and histologic findings. […] SRUS is an uncommon benign disorder of defecation and is difficult to distinguish from malignancy and IBD because of variable clinical and endoscopic manifestations. […] SRUS accompanied by IBD is extremely rare, and an accurate differential diagnosis is difficult to achieve. […] To date, only three cases of SRUS associated with UC (including the present case) have been reported in the medical literature.

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

  https://www.irjournal.org/journal/view.php?number=54

  Although coexistence of SRUS and UC is extremely rare, we suggest that the association between SRUS and UC may not be fortuitous. Additional studies are warranted to clarify the relationship between SRUS and UC, including underlying mechanisms responsible for their development and predisposing factors.

• #41 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 management of SRUS requires a multidisciplinary approach, beginning with conservative measures, such as dietary modification, bowel training, and biofeedback therapy aimed at correcting defecatory dysfunction. […] This article provides a comprehensive analysis of 36 cases of solitary rectal ulcers identified in the endoscopy unit of the Giresun Education and Research Hospital between January 2020 and January 2023. […] The significant age differences among the symptom groups indicated that older patients were more likely to present with hematochezia. […] A significant finding in our study was the prevalence of ulcerative colitis as a primary diagnosis in 77.78% of patients. […] These findings underscore the potential of mesalamine and APC as effective complementary options for SRUS management, particularly for patients with persistent symptoms or active bleeding. […] 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.

• #42 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. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse.

• #43 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. […] This study included patients diagnosed with SRUS between January 2020 and January 2024. […] A total of 36 patients diagnosed with SRUS were included, with the majority being male (80.6%), and the mean age of participants was 75.6 years. […] Hematochezia was identified as the most common initial symptom (61.1%), followed by abdominal pain (16.7%) and constipation (11.1%). […] This study offers a comprehensive analysis of SRUS, emphasizing the importance of detailed clinical and laboratory evaluation. […] 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.

• #44 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. […] Its exact prevalence is not clearly known but a figure of 1:100,000 per year is usually reported and there seems to be no sexual or age preference. […] 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. […] 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.

• #45 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. […] A total of 116 patients were evaluated. The mean age was 37.416.6 (range: 1380) years, 61 (53%) of the patients were male. […] Endoscopically, solitary and multiple lesions were present in 79 (68%) and 33 (28%) patients respectively; ulcerative lesions in 90 (78%), polypoidal in 29 (25%), erythematous patches in 3 (2.5%) and petechial spots in one patient. […] Associated underlying conditions were hemorrhoids in 7 (6%), hyperplastic polyps in 4 (3.5%), adenomatous polyps in 2(2%), history of ulcerative colitis in 3 (2.5%) while adenocarcinoma of colon was observed in two patients.

• #46 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

  Only 35% of cases have a solitary ulcer of the rectal wall. 22% have multiple ulcers. 43% have no ulcers at all. It typically occurs in young adults, with a slightly increased female predilection. […] 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.

• #47 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

  Associated underlying conditions were hemorrhoids in 7 (6%) (Figure1), hyperplastic polyps in 4 (3.5%), adenomatous polyps in 2 (2%) and adenocarcinoma of colon in two patients (Figure6) while 3 patients had history of ulcerative colitis. […] The findings in the present series correspond with the literature in terming SRUS as a misnomer. […] Histopathological analysis forms the cornerstone of diagnosing SRUS and is a requisite to rule out any other underlying disease. […] Inconsistency in morphologic appearances of associated lesions increases the likelihood of delayed or erroneous diagnosis of SRUS. […] Present study reveals that the rectal bleeding, abdominal pain and constipation were the most common symptoms encountered in patients with SRUS. […] A high index of suspicion is therefore required to diagnose potentially serious disease by repeated examinations and biopsies for histopathology.

• #48 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 average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years). It has been reported that 75% to 80% of children with SRUS are boys as similar with our report. […] The pathophysiology of SRUS is incompletely understood. It is supposed to be due to secondary to ischemia and trauma to the rectal mucosa and paradoxical contraction of pelvic floor. The excessive straining generates a high intrarectal pressure which pushes the anterior rectal mucosa into the contracting puborectalis muscle resulting in pressure necrosis of rectal mucosa and the anterior rectal mucosa is frequently forced into the closed anal canal causing congestion, edema, and ulceration. […] 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.

• #49 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 average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years). It has been reported that 75% to 80% of children with SRUS are boys as similar with our report. […] The pathophysiology of SRUS is incompletely understood. It is supposed to be due to secondary to ischemia and trauma to the rectal mucosa and paradoxical contraction of pelvic floor. The excessive straining generates a high intrarectal pressure which pushes the anterior rectal mucosa into the contracting puborectalis muscle resulting in pressure necrosis of rectal mucosa and the anterior rectal mucosa is frequently forced into the closed anal canal causing congestion, edema, and ulceration. […] 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.

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

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

  In a quarter of patients, a delay in diagnosis or misdiagnosis of SRUS might occur because of inadequate rectal biopsy and failure to recognize the histopathological features of the disease. […] 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. […] Several treatment options have been used for SRUS, ranging from conservative treatment (i.e., diet and bulking agents), medical therapy, biofeedback and surgery. […] The choice of treatment depends upon the severity of symptoms and whether there is a rectal prolapse. […] Patient education and behavioral modification are the first steps in the treatment of SRUS. […] However, it would appear that conservative approaches are less useful when SRUS is associated with an advanced grade of rectal intussusception, extensive inflammation, established fibrosis and/or reducible external prolapse. […] Surgery remains an option for patients not responsive to conservative measures and biofeedback. […] The evidence regarding which approach is first-line for SRUS is unclear.

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

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

  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. The underlying etiology is not well understood, but it is secondary to ischemic changes and trauma in the rectum associated with paradoxical contraction of the pelvic floor and the external anal sphincter muscles; rectal prolapse has also been implicated in the pathogenesis. 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 a juvenile polyps. SRUS should be suspected in patients experiencing rectal discharge of blood and mucus in addition to previous disorders of evacuation. We herein report six pediatric cases with SRUS.

• #52 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

  SRUS may manifest on endoscopy as multiple ulcers, polypoidal growth and erythematous patches and has shown to share clinicopathological features with rectal prolapse, proctitis cystica profunda (PCP) and inflammatory cloacogenic polyp; therefore collectively grouped as mucosal prolapse syndrome. […] This may be associated with underlying conditions such as polyps, ulcerative colitis, hemorrhoids and malignancy. High index of suspicion is required to diagnose potentially serious disease by repeated endoscopies with biopsies to look for potentially serious underlying conditions associated with SRUS. […] The data on clinical and endoscopic spectrum of SRUS is scarce in this region of the world. […] The clinical presentation and endoscopic findings are summarized in Tables1 and 2 respectively.

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

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

  Anemia is not consistently present in SRUS. A prolonged period of misdiagnosis may cause anemia secondary to massive bleeding, but blood transfusion in SRUS is rare. […] Rectal prolapse, either occult or overt is well documented in SRUS. […] Therapeutic experience in children with SRUS, is limited, with variable treatment protocols and clinical outcomes. Current treatment includes bulking agents (lactulose), enemas (steroid and mesalamine), oral 5-ASA, sucralfate, bowel retraining with or without biofeedback, endoscopical steroid injection and surgery (rectopexy, excision of ulcer) in refractory cases not responding to conservative treatments. […] In conclusion, physicians must have a high index of suspicion for SRUS in patients who present with rectal discharge of blood and mucus and previous disorders of evacuation or in whom clinical improvement is not achieved with conservative treatments given. It is mandatory to take biopsy specimens from the involved area to confirm the diagnosis and to exclude other diseases.

• #54 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 rare benign rectal disease that is characterized by a combination of symptoms, clinical findings and histological abnormalities. However, SRUS is an infrequent disease that is easily underdiagnosed, with an estimated annual prevalence of one in 100,000 persons. It occurs most commonly in the third decade in men and in the fourth decade in women. […] SRUS is easily misdiagnosed as rectal cancer, based on the similarity in the symptomatic profiles and endoscopic features, which include bleeding, mucus discharge, and chronic and severe constipation. To date, these histological features have been helpful in distinguishing SRUS from malignancies. […] 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.

• #55 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

  Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. […] The prevalence of SRUS is one per 100,000 person-years in children. […] Approximately 75-80% of the patients are males. […] The low prevalence of SRUS in children has been suggested to be because it is often unrecognized or misdiagnosed. […] The diagnosis can be difficult because the endoscopic and histopathological findings of SRUS may mimic other disorders of the rectum. […] This study is the first large series on Turkish children. […] An increased awareness of SRUS in children will increase the rate of early diagnosis and treatment, allowing remission in more patients. […] The median time to diagnosis was 24 months. […] The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04).

• #56 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 prevalence of SRUS is one per 100,000 person-years in children. […] Approximately 75-80% of the patients are males. […] The low prevalence of SRUS in children has been suggested to be because it is often unrecognized or misdiagnosed. […] The diagnosis can be difficult because the endoscopic and histopathological findings of SRUS may mimic other disorders of the rectum. […] This study aimed to increase clinicians awareness of SRUS in children admitted with hematochezia and to contribute to the literature by reporting the symptoms and the endoscopic and histopathological findings in this first large series conducted on Turkish children. […] This study is the first large series on Turkish children. An increased awareness of SRUS in children will increase the rate of early diagnosis and treatment, allowing remission in more patients.

• #57

  http://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. […] Although solitary rectal ulcer syndrome is still relatively rare, the incidence of this condition in children is increasing. […] Solitary rectal ulcer, although fairly common in adults, is regarded as very rare condition in children. […] 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.

• #58

  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. […] 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. […] Although solitary rectal ulcer syndrome is still relatively rare, the incidence of this condition in children is increasing. Clinicians should be aware of this problem to avoid delayed diagnosis and management. […] Solitary rectal ulcer, although fairly common in adults, is regarded as very rare condition in children. […] 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.

• #59 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

  SRUS may manifest on endoscopy as multiple ulcers, polypoidal growth and erythematous patches and has shown to share clinicopathological features with rectal prolapse, proctitis cystica profunda (PCP) and inflammatory cloacogenic polyp; therefore collectively grouped as mucosal prolapse syndrome. […] This may be associated with underlying conditions such as polyps, ulcerative colitis, hemorrhoids and malignancy. High index of suspicion is required to diagnose potentially serious disease by repeated endoscopies with biopsies to look for potentially serious underlying conditions associated with SRUS. […] The data on clinical and endoscopic spectrum of SRUS is scarce in this region of the world. […] The clinical presentation and endoscopic findings are summarized in Tables1 and 2 respectively.

• #60 Solitary Rectal Ulcer Syndrome and Stercoral Ulcers | Abdominal Key

  https://abdominalkey.com/solitary-rectal-ulcer-syndrome-and-stercoral-ulcers/

  Solitary rectal ulcer syndrome (SRUS) is a rare syndrome with a prevalence of less than 1 in 100,000 per year. […] The current literature comprises case series studies and sporadic case reports. […] Due to its rarity, nonspecific signs, and symptoms and various causes, SRUS diagnosis is delayed in many cases. […] The therapeutic outcomes varies. […] Identifying the correct foundation allows proper treatment with optimal results.

• #61 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

  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. […] With this, additional studies of larger pediatric populations with SRUS and long-term follow-up are also necessary in creating reliable treatment protocols.

• #62 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

  Increasing the awareness of this condition will result in the identification of more cases in Trkiye. […] The treatment of SRUS varies according to the severity of symptoms. […] 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).

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

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

  Anemia is not consistently present in SRUS. A prolonged period of misdiagnosis may cause anemia secondary to massive bleeding, but blood transfusion in SRUS is rare. […] Rectal prolapse, either occult or overt is well documented in SRUS. […] Therapeutic experience in children with SRUS, is limited, with variable treatment protocols and clinical outcomes. Current treatment includes bulking agents (lactulose), enemas (steroid and mesalamine), oral 5-ASA, sucralfate, bowel retraining with or without biofeedback, endoscopical steroid injection and surgery (rectopexy, excision of ulcer) in refractory cases not responding to conservative treatments. […] In conclusion, physicians must have a high index of suspicion for SRUS in patients who present with rectal discharge of blood and mucus and previous disorders of evacuation or in whom clinical improvement is not achieved with conservative treatments given. It is mandatory to take biopsy specimens from the involved area to confirm the diagnosis and to exclude other diseases.

• #64

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

  Rectal bleeding was of mild degree and no patient required blood transfusion. […] 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. […] Histopathology is mainspring for the diagnosis of SRUS and also for excluding any other underlying diseases. […] The histological findings are highly characteristic despite the inconsistency and discrepancy on the clinical and endoscopic findings. […] In conclusion, functional evacuation disorder was more common inpatients with SRUS as evidenced by abnormal balloon expulsion test and sphincter relaxation.

• #65 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. In children this condition appears to be infrequent, underdiagnosed or in some cases misdiagnosed. Most patients with SRUS, both adults and children, present with rectal bleeding, mucous discharge, straining, tenesmus, and rectal pain. Accurate diagnosis and treatment of SRUS still remains a clinical challenge for several reasons. […] The pediatric experience with this condition is limited and there is a lack of diagnostic and therapeutic protocols. It will be of benefit for pediatric gastrologists to familiarize themselves with this entity, so that patients can be diagnosed correctly before long duration of symptoms. Awareness of the disease may result in more diagnosed cases and help better understanding of the natural history.

• #66 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 is a chronic, benign disorder of the rectum, occurring most commonly in young adults. This entity is either rare in children, goes unrecognized or is misdiagnosed, with slightly more than twenty documented cases in the English literature. […] 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. Solitary rectal ulcer syndrome should be considered only in the differential diagnosis of idiopathic inflammatory bowel disease limited to the rectum and distal sigmoid colon, but not in the differential diagnosis of more extensive disease. A report of a larger series with long-term follow-up is required to establish treatment protocols in children.

• #67 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

  Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. […] The prevalence of SRUS is one per 100,000 person-years in children. […] Approximately 75-80% of the patients are males. […] The low prevalence of SRUS in children has been suggested to be because it is often unrecognized or misdiagnosed. […] The diagnosis can be difficult because the endoscopic and histopathological findings of SRUS may mimic other disorders of the rectum. […] This study is the first large series on Turkish children. […] An increased awareness of SRUS in children will increase the rate of early diagnosis and treatment, allowing remission in more patients. […] The median time to diagnosis was 24 months. […] The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04).

• #68 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. […] It is a well-known syndrome in adults, but thought to be rarer in children due to misdiagnosis or underdiagnosis. […] In children, this interval ranges from 1.2 to 5.5 years, with an average of 5 years from onset of symptoms to diagnosis. […] In a large case series of Iranian children, 12 of 256 children (5%) were diagnosed with SRUS. […] The most common presenting symptoms include rectal bleeding, constipation, abdominal pain and alternating diarrhea. […] 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.

• #69 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 average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years). It has been reported that 75% to 80% of children with SRUS are boys as similar with our report. […] The pathophysiology of SRUS is incompletely understood. It is supposed to be due to secondary to ischemia and trauma to the rectal mucosa and paradoxical contraction of pelvic floor. The excessive straining generates a high intrarectal pressure which pushes the anterior rectal mucosa into the contracting puborectalis muscle resulting in pressure necrosis of rectal mucosa and the anterior rectal mucosa is frequently forced into the closed anal canal causing congestion, edema, and ulceration. […] 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.

• #70 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

  Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. […] The prevalence of SRUS is one per 100,000 person-years in children. […] Approximately 75-80% of the patients are males. […] The low prevalence of SRUS in children has been suggested to be because it is often unrecognized or misdiagnosed. […] The diagnosis can be difficult because the endoscopic and histopathological findings of SRUS may mimic other disorders of the rectum. […] This study is the first large series on Turkish children. […] An increased awareness of SRUS in children will increase the rate of early diagnosis and treatment, allowing remission in more patients. […] The median time to diagnosis was 24 months. […] The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04).

• #71 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 syndrome affects men and women equally, and can occur at any age although it typically affects young adults with up to 25% of patients aged over 60 at presentation. […] The most commonly accepted etiopathogenetic mechanism of SRUS is a hypoperfusion-induced chronic mucosal ischemic injury to the rectal mucosa. […] In the current study, the youngest case was 6 years old, and the oldest patient was 16 years. […] Our study showed that most cases were aged 6 to 10 years. […] The most common presentation was bleeding per rectum followed by constipation. […] Endoscopic findings in our study showed 7 cases with single ulcers, 2 cases with multiple ulcers, and a single case with normal endoscopy findings.

• #72 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 average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years). It has been reported that 75% to 80% of children with SRUS are boys as similar with our report. […] The pathophysiology of SRUS is incompletely understood. It is supposed to be due to secondary to ischemia and trauma to the rectal mucosa and paradoxical contraction of pelvic floor. The excessive straining generates a high intrarectal pressure which pushes the anterior rectal mucosa into the contracting puborectalis muscle resulting in pressure necrosis of rectal mucosa and the anterior rectal mucosa is frequently forced into the closed anal canal causing congestion, edema, and ulceration. […] 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.

• #73 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 syndrome affects men and women equally, and can occur at any age although it typically affects young adults with up to 25% of patients aged over 60 at presentation. […] The most commonly accepted etiopathogenetic mechanism of SRUS is a hypoperfusion-induced chronic mucosal ischemic injury to the rectal mucosa. […] In the current study, the youngest case was 6 years old, and the oldest patient was 16 years. […] Our study showed that most cases were aged 6 to 10 years. […] The most common presentation was bleeding per rectum followed by constipation. […] Endoscopic findings in our study showed 7 cases with single ulcers, 2 cases with multiple ulcers, and a single case with normal endoscopy findings.

• #74 Solitary rectal ulcer syndrome presenting as polypoid mass lesions in a young girl

  https://www.wjgnet.com/1948-5204/full/v2/i8/332.htm

  Solitary rectal ulcer syndrome (SRUS) is a rare benign disease of the rectum, which predominately affects young adults aged between 30 and 50 years with a prevalence of 1 in 100000 people per year. […] SRUS is rare in children and its description is largely limited to case reports. […] The clinical presentation of SRUS is diverse. Patients commonly present with obstructed defecation, rectal bleeding or prolapsed rectal mucosa either overt or occult. […] In adults, 25%-32% of SRUS may appear as polypoid lesions. […] Among the cases reported in children, the polypoid variant is very rare and has previously been reported in only two patients. […] Rectal prolapse is associated with 16%-59% of SRUS in adults. […] Therapeutic experience in children with SRUS is limited, with widely varying reported treatment protocols and poorly documented clinical outcomes. […] In conclusion, the presence of a rectal polypoid mass with ulceration in a child with obstructed defecation and rectal bleeding should raise the suspicion of SRUS.

• #75 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.

• #76 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.

• #77 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

  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. […] With this, additional studies of larger pediatric populations with SRUS and long-term follow-up are also necessary in creating reliable treatment protocols.

• #78 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 rare benign rectal disease that is characterized by a combination of symptoms, clinical findings and histological abnormalities. However, SRUS is an infrequent disease that is easily underdiagnosed, with an estimated annual prevalence of one in 100,000 persons. It occurs most commonly in the third decade in men and in the fourth decade in women. […] SRUS is easily misdiagnosed as rectal cancer, based on the similarity in the symptomatic profiles and endoscopic features, which include bleeding, mucus discharge, and chronic and severe constipation. To date, these histological features have been helpful in distinguishing SRUS from malignancies. […] 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.

• #79 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. […] Rectal bleeding and abdominal pain are known as the main symptoms of SRUS. Usually, it is misdiagnosed through colonoscopy; 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. […] Since SRUS has a benign disease course, it can be managed with conservative treatment. […] In conclusion, SRUS should always be considered in patients with malignant-mimicking rectal cancer. However, we believe it is important not to miss a diagnosis of rectal cancer over the diagnosis of SRUS.

• #80 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. […] Its exact prevalence is not clearly known but a figure of 1:100,000 per year is usually reported and there seems to be no sexual or age preference. […] 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. […] 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.

• #81

  https://journals.lww.com/ajg/fulltext/2022/10002/s2109_posterior_solitary_rectal_ulcer_syndrome.2109.aspx

  Solitary rectal ulcer syndrome (SRUS) is a rare colorectal disorder that presents as bright red blood per rectum (BRBPR), rectal pain, straining, incomplete evacuation, and rectal prolapse. The incidence of SRUS is 1: 100,000 individuals per year. […] Differential diagnoses include inflammatory bowel disease (IBD), ischemic colitis, pseudomembranous colitis, and malignancy. […] The pathogenesis behind SRUS is poorly understood but thought to be a result of rectal prolapse and rectal trauma by 2 different mechanisms. […] Treatment is biofeedback therapy and topical therapies. Surgery is a last resort.

• #82 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 is a chronic, benign disorder of the rectum, occurring most commonly in young adults. This entity is either rare in children, goes unrecognized or is misdiagnosed, with slightly more than twenty documented cases in the English literature. […] 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. Solitary rectal ulcer syndrome should be considered only in the differential diagnosis of idiopathic inflammatory bowel disease limited to the rectum and distal sigmoid colon, but not in the differential diagnosis of more extensive disease. A report of a larger series with long-term follow-up is required to establish treatment protocols in children.

• #83

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

  Solitary rectal ulcer syndrome (SRUS) is a chronic, benign defecation disorder often related to excessive straining. […] SRUS is an infrequent, unrecognized and misdiagnosed disorder, with an estimated prevalence of 1 in 100 000 persons per year. […] The diagnosis of SRUS is based on symptomatology in combination with endoscopic and histologic findings. […] The endoscopic spectrum of SRUS may vary from simple hyperemic mucosa to small or giant ulcers to broad-based polypoid lesions in different sizes and numbers. […] SRUS is a chronic benign disorder with diverse clinical and endoscopic features. […] The most common diagnostic confusion was with inflammatory bowel disease and neoplastic polyp. […] The most common presenting symptoms of SRUS in the present study were rectal bleeding and constipation.

• #84 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. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse.

• #85 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 a rare benign disorder characterized by a combination of symptoms, endoscopic findings, and histological abnormalities. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. […] The cause of SRUS is unknown. […] 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.

• #86 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 average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years). It has been reported that 75% to 80% of children with SRUS are boys as similar with our report. […] The pathophysiology of SRUS is incompletely understood. It is supposed to be due to secondary to ischemia and trauma to the rectal mucosa and paradoxical contraction of pelvic floor. The excessive straining generates a high intrarectal pressure which pushes the anterior rectal mucosa into the contracting puborectalis muscle resulting in pressure necrosis of rectal mucosa and the anterior rectal mucosa is frequently forced into the closed anal canal causing congestion, edema, and ulceration. […] 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.

• #87 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 a rare benign disorder characterized by a combination of symptoms, endoscopic findings, and histological abnormalities. […] SRUS is an infrequent and underdiagnosed disorder, with an estimated annual prevalence of one in 100000 persons. […] Men and women are affected equally, with a small predominance in women. […] However, it has been described in children and in the geriatric population. […] The average time from the onset of symptoms to diagnosis is 5 years, ranging from 3 mo to 30 years in adults, which is longer than in pediatric patients (1.2-5.5 years). […] The underlying etiology and pathogenesis are not fully understood but multiple factors may be involved. […] The cause of SRUS is unknown. […] 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.

• #88 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 average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years). It has been reported that 75% to 80% of children with SRUS are boys as similar with our report. […] The pathophysiology of SRUS is incompletely understood. It is supposed to be due to secondary to ischemia and trauma to the rectal mucosa and paradoxical contraction of pelvic floor. The excessive straining generates a high intrarectal pressure which pushes the anterior rectal mucosa into the contracting puborectalis muscle resulting in pressure necrosis of rectal mucosa and the anterior rectal mucosa is frequently forced into the closed anal canal causing congestion, edema, and ulceration. […] 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.

• #89 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

  Increasing the awareness of this condition will result in the identification of more cases in Trkiye. […] The treatment of SRUS varies according to the severity of symptoms. […] 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).

• #90 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

  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. […] With this, additional studies of larger pediatric populations with SRUS and long-term follow-up are also necessary in creating reliable treatment protocols.

• #91 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 is a chronic, benign disorder of the rectum, occurring most commonly in young adults. This entity is either rare in children, goes unrecognized or is misdiagnosed, with slightly more than twenty documented cases in the English literature. […] 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. Solitary rectal ulcer syndrome should be considered only in the differential diagnosis of idiopathic inflammatory bowel disease limited to the rectum and distal sigmoid colon, but not in the differential diagnosis of more extensive disease. A report of a larger series with long-term follow-up is required to establish treatment protocols in children.

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