Curriculum for Specialty Certificate Examination in Gastroenterology

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Monday 27 May 2013

Solitary rectal ulcer syndrome

Solitary rectal ulcer syndrome is recognized as a chronic benign inflammatory disorder characterized by rectal bleeding, diarrhea, constipation, and anorectal pain.It is believed that SRUS results from repeated mucosal trauma with ischemia of the rectal wall from straining at defecation.
The correct diagnosis of SRUS depends on recognition of specific histopathological features termed "fibromuscular obliteration" on biopsy specimens.




 A solitary rectal ulcer, consisting of a polypoid large bowel mucosa with fibrotic lamina propria and migrating smooth muscle fibers. 

4 comments:

  1. What is the most effective treatment for solitary rectal ulcer syndrome?
    1-steroids enema
    2-Mesalasine enemas
    3-mesalasine suppos
    4-Bio feed back

    The most effective treatment for solitary rectal ulcer syndrome is biofeedback. It has been associated with an increase in local blood flow. Other treatments include local agents, improving bowel habits, and surgery. Local agents such as topical steroids and sulfasalazine are not effective. Sucralfate enemas and human fibrin sealant have been effective in small studies. The addition of fiber as a bulking agent along with bowel habit training to reduce straining may result in symptomatic improvement in patients with mild disease. Behavioral therapy or biofeedback is the first line of therapy for patients with more severe disease and improves symptoms in more than 50% of patients, although ulcer healing is seen in a minority. This therapy aims at bowel habit training with normalization of pelvic floor coordination. Jarrett and associates demonstrated that biofeedback resulted in improved rectal blood flow, which was associated with a successful clinical outcome. Surgery is indicated in patients with severe disease who do not respond to medical or biofeedback therapy. Surgical procedures include operations for rectal prolapse, excision of the ulcer, and colostomy.

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  2. Solitary rectal ulcers are most commonly located
    1-On the posterior wall 2 to 3 cm from the anal verge
    2-On the posterior wall 7 to 10 cm from the anal verge
    3-On the anterior wall 2 to 3 cm from the anal verge
    4-On the anterior wall 7 to 10 cm from the anal verge

    The anterior wall of the rectum, 7 to 10 cm from the anal verge, is the most common area of prolapse into the anal canal, and this area corresponds to the usual location of ulceration in solitary rectal ulcer syndrome.

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