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Faghih Dinevari M, Eftekharsadat A, Tarverdizadeh M, Rasulimanesh SM, Riazi A, Jabbaripour Sarmadian A, Abbasian S. Rectal bleeding as a symptom of solitary rectal ulcer syndrome mimicking rectal neoplasm on colonoscopy: A case report. Clin Case Rep 2023; 11:e7277. [PMID: 37113638 PMCID: PMC10126758 DOI: 10.1002/ccr3.7277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Patients complaining of rectal bleeding, constipation, and a suspicious mass in colonoscopy should undergo biopsy. Histological features such as fibromuscular obliteration in the lamina propria favor SRUS, a benign disorder.
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Affiliation(s)
- Masood Faghih Dinevari
- Liver and Gastrointestinal Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | | | - Mahdi Tarverdizadeh
- Liver and Gastrointestinal Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | | | - Ali Riazi
- Liver and Gastrointestinal Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | | | - Samaneh Abbasian
- Liver and Gastrointestinal Diseases Research CenterTabriz University of Medical SciencesTabrizIran
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Rectal Ulcer After Rectal Washing With a Bidet Toilet. ACG Case Rep J 2022; 9:e00754. [PMID: 35187188 PMCID: PMC8849414 DOI: 10.14309/crj.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
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Abusharifah O, Bokhary RY, Mosli MH, Saadah OI. Solitary rectal ulcer syndrome in children and adolescents: a descriptive clinicopathologic study. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2021; 14:399-407. [PMID: 33936361 PMCID: PMC8085826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of the rectum. While benign, it can cause concern for patients and affect quality of life. Reported studies on SRUS worldwide are scarce. The aim of this study is to describe the clinicopathologic characteristics of SRUS in a cohort of children based in Saudi Arabia. In this study, children with a confirmed diagnosis of SRUS at King Abdulaziz University Hospital (KAUH) were included, during the period November 2003 to November 2017. Data were collected from hospital medical records. The study comprised twenty-one patients: 17 males (81%) and 4 females (19%); the median age was 11.4 years (range, 5.43-17.9 years). The most common presenting symptoms were rectal bleeding in 21 patients (100%), passage of mucus in 16 (76.1%), abdominal pain in 14 (66.6%), constipation in 13 (61.9%), straining in 9 (42.9%), and rectal prolapse in 5 (23.8%). The most common finding at initial colonoscopy was a single ulcer in 7 patients (33.3%), multiple ulcers in 6 (28.5%), polypoid lesions in 5 (23.8%), and hyperemic mucosa in 3 (14.2%). All patients received medical treatment and 14 (81%) continued to manifest one or more of the symptoms following treatment, which required subsequent modification of the treatment course. None of the patients required surgery. In conclusion, the study found rectal bleeding to be the most common presentation, with a single ulcer being the most prevalent lesion in endoscopy. Treatment response was variable, but almost half of patients reported relief of symptoms following treatment.
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Affiliation(s)
- Ohood Abusharifah
- Pediatric Gastroenterology Unit, Department of Pediatrics, Faculty of Medicine, King Abdulaziz UniversityJeddah, Saudi Arabia
- Departemnt of Pediatrics, Maternity and Children HospitalAbha, Saudi Arabia
| | - Rana Y Bokhary
- The Department of Pathology, Faculty of Medicine, King Abdulaziz UniversityJeddah, Saudi Arabia
| | - Mahmoud H Mosli
- The Department of Internal Medicine, Faculty of Medicine, King Abdulaziz UniversityJeddah, Saudi Arabia
| | - Omar I Saadah
- Pediatric Gastroenterology Unit, Department of Pediatrics, Faculty of Medicine, King Abdulaziz UniversityJeddah, Saudi Arabia
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Tang X, Han C, Sheng L, Yang M, Liu J, Ding Z, Hou X. Rectal mucosal prolapse with an emphasis on endoscopic ultrasound appearance. Dig Liver Dis 2021; 53:427-433. [PMID: 33478871 DOI: 10.1016/j.dld.2020.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/03/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
AIM The diagnosis of mucosal prolapse syndrome (MPS) continues to be a challenge. Endoscopic ultrasound (EUS) is of clinical value in anorectal diseases. This study seeks to investigate the use of EUS in the diagnosis of MPS. METHODS A total of 39 patients diagnosed with MPS between June 2015 to December 2019 were included in this study. Their clinical histories, endoscopic images, EUS images, and pathological data were retrospectively collected, and the EUS images were reviewed to summarize the characteristics of MPS. RESULTS In total, 39 MPS patients were enrolled. The main presenting symptoms were bleeding (61.5%) and constipation (53.8%). Gross appearance of the rectal lesions was mainly classified into three types: 51.3% of the lesions were polypoidal/nodular, 33.3% were ulcerative and 15.4% were flat with erythematous mucosa only. A total of 10 patients underwent EUS operation. With regard to the EUS appearance of MPS, four patients with polypoidal/nodular lesions showed thickening of the mucosa on EUS. The diffuse thickening of the mucosa-submucosa layer and disappearance of the architectural structure was observed in four patients with ulcerative lesions. Finally, the thickening of the muscularis propria was observed in two flat lesions. The serosal layers were intact in all the MPS patients. Neither blood flow signals nor regional lymph nodes were observed on EUS. CONCLUSION The EUS characteristics for MPS corresponding to different gross appearance can be classified into three types. These findings suggest that EUS is useful in the diagnosis of MPS.
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Affiliation(s)
- Xuelian Tang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chaoqun Han
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Liping Sheng
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ming Yang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jun Liu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhen Ding
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Xiaohua Hou
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Qari Y, Mosli M. A systematic review and meta-analysis of the efficacy of medical treatments for the management of solitary rectal ulcer syndrome. Saudi J Gastroenterol 2019; 26:4-12. [PMID: 31898642 PMCID: PMC7045767 DOI: 10.4103/sjg.sjg_213_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/AIM Solitary rectal ulcer syndrome (SRUS) is a benign, poorly understood disorder that is difficult to manage. Medical interventions such as sucralfate, sulfasalzine, human fibrin, and a high fibre diet are reported as the first line of treatment. The aim of this study is to perform a systematic review and meta-analysis of the efficacy of medical treatments for SRUS. MATERIALS AND METHODS Databases including PubMed, Cochrane, and Embase were searched for randomised clinical trials (RCT) and observational studies that evaluated medical treatments for SRUS. Two authors independently performed selection of eligible studies based on eligiblity criteria. Data extraction from potentially eligible studies was carried out according to predefined data collection methods. Medical treatments, including sucralfate, sulfasalzine, human fibrin, a high fibre diet, and psyllium powder as a single or combination therapy were compared to placebo alone or combined with other treatments. The primary outcome was the proportion of patients with ulcer remission; this was presented as pooled prevalence (PP) with a 95% confidence interval (CI). The I2 value and Q statistic test were used to test for heterogeneity. In the presence of heterogeneity, a random-effects model was applied. RESULTS A total of 9 studies with 216 patients (males = 118, females = 98) diagnosed with SRUS were analysed in the final meta-analysis. The pooled effect estimate of treatment efficacy revealed that, of the patients receiving medical treatment, 57% had resolution of their ulcers (PP 0.57; 95% CI; 0.41 to 0.73). Statistically significant heterogeneity was observed (I2 = 63%; τ2 = 0.64, P= <0.01). The scarcity of RCTs comparing medical treatments with other interventions was a major limitation. CONCLUSIONS The majority of patients receiving medical treatment for the management of SRUS experience resolution of their ulcers.
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Affiliation(s)
- Yousef Qari
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahmoud Mosli
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,Address for correspondence: Dr. Mahmoud Mosli, Department of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia. E-mail:
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Rana SS, Basher RK, Sharma RK, Gupta R. Unusual polypoid mass lesion in the rectum. Ann Gastroenterol 2018; 31:752. [PMID: 30386130 PMCID: PMC6191860 DOI: 10.20524/aog.2018.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/20/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology (Surinder Singh Rana, Ravi Kumar Sharma), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajender Kumar Basher
- Nuclear Medicine (Rajender Kumar Basher), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ravi Kumar Sharma
- Department of Gastroenterology (Surinder Singh Rana, Ravi Kumar Sharma), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Surgery (Rajesh Gupta), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Solitary Rectal Ulcer Syndrome in Children: A Case Series Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1020:105-112. [DOI: 10.1007/5584_2017_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Dehghani SM, Bahmanyar M, Geramizadeh B, Alizadeh A, Haghighat M. Solitary rectal ulcer syndrome: Is it really a rare condition in children? World J Clin Pediatr 2016; 5:343-348. [PMID: 27610352 PMCID: PMC4978629 DOI: 10.5409/wjcp.v5.i3.343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/27/2016] [Accepted: 04/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer.
METHODS: Fifty-five children with a confirmed diagnosis of solitary rectal ulcer were studied in a period of 11 years from March 2003 to March 2014. All data were collected from the patients, their parents and medical records in the hospital.
RESULTS: From 55 studied patients, 41 were male (74.5%) and 14 female (25.5%). The mean age of the patients was 10.4 ± 3.7 years and the average time period from the beginning of symptoms to diagnosis of solitary rectal ulcer was 15.5 ± 11.2 mo. The most common clinical symptoms in our patients were rectal bleeding (n = 54, 98.2%) and straining during defecation or forceful defecation (n = 50, 90.9%). Other symptoms were as follows respectively: Sense of incomplete evacuation (n = 34, 61.8%), mucorrhea (n = 29, 52.7%), constipation (n = 14, 25.4%), tenesmus and cramping (n = 10, 18.2%), diarrhea (n = 9, 16.4%), and rectal pain (n = 5, 9.1%). The colonoscopic examination revealed 67.3% ulcer, 12.7% polypoid lesions, 10.9% erythema, 7.3% both polypoid lesions and ulcer, and 1.8% normal. Most of the lesions were in the rectosigmoid area at a distance of 4-6 cm from the anal margin. Finally, 69.8% of the patients recovered successfully with conservative, medical and surgical management.
CONCLUSION: The study revealed that solitary rectal ulcer is not so uncommon despite what was seen in previous studies. As the most common symptom was rectal bleeding, clinicians and pathologists should be familiar with this disorder and common symptoms in order to prevent its complications with early diagnosis.
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Jung SH, Kim YB, Kim HJ, Hwang JW, Lee SH, Jung SJ, Park JK. A Case of Solitary Rectal Ulcer Syndrome in a 16-year-old Girl Presented with Iron Deficiency Anemia. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sun Hee Jung
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Bae Kim
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Jin Kim
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Won Hwang
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Heon Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Su Jin Jung
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Kyoung Park
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Abstract
Solitary rectal ulcer syndrome is a rare benign disorder in children which often goes unrecognized or easily misdiagnosed with other common diseases. It usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, and lower abdominal pain. The rectal bleeding varies from a little fresh blood to severe hemorrhage that requires blood transfusion. We report herein a pediatric case of solitary rectal ulcer syndrome who admitted to pediatric emergency department with severe rectal bleeding for reminding this rare syndrome.
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Urgancı N, Kalyoncu D, Eken KG. Solitary rectal ulcer syndrome in children: a report of six cases. Gut Liver 2013; 7:752-5. [PMID: 24312719 PMCID: PMC3848538 DOI: 10.5009/gnl.2013.7.6.752] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/21/2013] [Accepted: 07/04/2013] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Nafiye Urgancı
- Division of Pediatric Gastroenterology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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Dehghani SM, Malekpour A, Haghighat M. Solitary rectal ulcer syndrome in children: A literature review. World J Gastroenterol 2012; 18:6541-5. [PMID: 23236227 PMCID: PMC3516213 DOI: 10.3748/wjg.v18.i45.6541] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/20/2012] [Accepted: 09/29/2012] [Indexed: 02/06/2023] Open
Abstract
Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults and less in children. It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding, copious mucus discharge, feeling of incomplete defecation, and rarely rectal prolapse. SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings. The current treatments are suboptimal, and despite correct diagnosis, outcomes can be unsatisfactory. Some treatment protocols for SRUS include conservative management such as family reassurance, regulation of toilet habits, avoidance of straining, encouragement of a high-fiber diet, topical treatments with salicylate, sulfasalazine, steroids and sucralfate, and surgery. In children, SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases, however, it is being reported more than in the past. This condition in children is benign; however, morbidity is an important problem as reflected by persistence of symptoms, especially rectal bleeding. In this review, we discuss current diagnosis and treatment for SRUS.
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The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases. BMC Gastroenterol 2012; 12:72. [PMID: 22697798 PMCID: PMC3444426 DOI: 10.1186/1471-230x-12-72] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 05/22/2012] [Indexed: 02/06/2023] Open
Abstract
Background 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. Methods All the patients diagnosed with SRUS histologically from January 1990 to February 2011 at The Aga Khan University, Karachi were included in the study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic and histological findings. Results A total of 116 patients were evaluated. The mean age was 37.4 ± 16.6 (range: 13–80) years, 61 (53%) of the patients were male. Bleeding per rectum was present in 82%, abdominal pain in 49%, constipation in 23% and diarrhea in 22%. 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. One patient had previous surgery for colonic carcinoma. Conclusion 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.
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