Waseem Raja* MD, D.N.B. Rohey Jan MD, Nita George MD, EDIC. S. K. Mathai MD, DM. B. Sebastian MD, D.M. Ashfaq Ahmad


Background: Solitary rectal ulcer syndrome (SRUS) is a rare disorder that has a wide spectrum of clinical presentation and variable endoscopic findings. Solitary rectal ulcer syndrome can present with rectal bleeding, straining during defecation, and a sense of incomplete evacuation. The term solitary rectal ulcer syndrome is a misnomer. Endoscopic findings in patients with SRUS, can range from mucosal erythema alone to single or multiple ulcers and polypoid/mass lesions.The aim of this study was to evaluate the variable clinical, endoscopic and histological features of SRUS. Methods: Patients diagnosed with SRUS histologically from March 2014 to April 2016 at Medical Trust hospital , a tertiary care referral centre in Kerala, were included in this study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with endoscopic and histological findings. Results: A total of 37 patients were identified, within the age group (range: 10–80) years, with slight female prepondance, 20 (54%) as compared to males 17(45% ). Rectal bleeding was the most common presenting symptom, seen in 30 patients ( 81%), followed by constipation (72.9%) ,straining at stools (64.8%) and perianal pain in 45.9%.Endoscopic findings revealed solitary and multiple lesions in 27 (79.2%) and 10 (27%) patients, respectively. On the basis of appearance, rectal ulceration was the most common finding seen in 25 patients. (67.5%)., while 9 (24.3%) had polypoidal/nodular lesions. Two (5.4 %) patients had erythematous mucosa only, while one patient had telengectatic spots. Associated conditions were hemorrhoids, in 8 patients (21.6%), hyperplastic polyps 5 (13.5%), adenomatous polyps in 3 (8.1%). Histologically fibromuscular obliteration and crypt distortion were seen in all cases (100%), surface ulceration in 94.5%. Vascular ectasia and mild chronic inflammation was a common findings. Conclusion: Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, with a wide spectrum of clinical presentation and variable endoscopic findings, therefore early diagnosis requires a high index of suspicion from both the Clinician and the pathologist especially, because the term ―solitary rectal ulcer‖ is a misnomer.

Keywords: Constipation, rectal, solitary, ulcers.

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