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Rectal Ulcer
Rectal Ulceration

Presentation

However, 20% of the patients presented with diarrhea and 26% were asymptomatic. These findings show that there is a wide spectrum of clinical presentations. This study [1] also showed that the endoscopic findings were variable. [saudijgastro.com]

We are presenting the clinical and endoscopic spectrum of SRUS patients who presented to our hospital in the last twenty-one years. [bmcgastroenterol.biomedcentral.com]

Abstract We describe a highly unusual case of solitary rectal ulcer syndrome (SRUS) that presented as a large polyp protruding from the anal canal. A 67-year-old man presented with rectal bleeding and mucus discharge. [academic.oup.com]

Epidemiology Typically younger patients - average age of presentation ~30 years in one study. [3] Rare. Clinical presentation Usually presents as BRBPR ~ 85% of cases. [3] Abdominal pain present in approx. 1/3. [3] May be very painful. [librepathology.org]

An unusual progressive form of benign rectal ulceration was found in an infant who presented with repeated episodes of rectal bleeding. The ulceration failed to respond to medical treatment but was cured by anterior resection of the rectum. [ncbi.nlm.nih.gov]

Entire Body System

  • Hunting

    CAS PubMed Google Scholar Katory M, Davies B, Clive K, Arasaradnam R, Skinner P, Brown S, Bagley J, Shorthouse AJ, Hunt LM, Slater R: Nicorandil and idiopathic anal ulceration. Dis Colon Rectum. 2005, 48: 1442-6. 10.1007/s10350-005-0027-7. [pssjournal.biomedcentral.com]

Workup

Laboratory workup revealed a WBC count of 8.6 × 109/L, hemoglobin level of 8.9 g/dL, and platelet count of 250,000/μL. [hindawi.com]

Colonoscopy

  • Colonic Ulcer

    Article CAS PubMed Google Scholar Titi MA, Seow C, Molloy RG: Nicorandil-induced colonic ulceration: a new cause of colonic ulceration. Report of four cases. Dis Colon Rectum. 2008, 51: 1570-3. 10.1007/s10350-008-9218-3. [pssjournal.biomedcentral.com]

Treatment

The clinical course of this complication and results of treatment options are unknown. [ncbi.nlm.nih.gov]

Management and Treatment What are the treatments for rectal ulcers? Treatment for rectal ulcers depends on the severity of your symptoms and whether you have another condition, such as inflammatory bowel disease. [my.clevelandclinic.org]

Anorectal physiological studies were performed in 11 patients before treatment. A standardised questionnaire was used before and after treatment, and all but two patients were examined after treatment. [gut.bmj.com]

The choice of treatment depends on the severity of the rectal ulcer and the ability of the patient to cope with a specific kind of treatment method. [mademan.com]

There are 4 basic pillars of treatment: hygiene-dietary measures, pharmacological treatment, biofeedback and surgery. [elsevier.es]

Prognosis

In these cases there are more therapeutic possibilities and the prognosis is slightly better. There is no method of choice for SRUS treatment and the prognosis is hard to predict. [omicsonline.org]

[…] distal rectum may be noted ulcer is variably identified Defecating proctogram 1 spastic pelvic floor syndrome: inability for the pelvic floor to relax during the straining phase rectal wall infoldIngs slowly leading to an intussusception Treatment and prognosis [radiopaedia.org]

Outlook / Prognosis What is the outlook for patients who have rectal ulcers? Your outlook depends on what is causing the ulcers to appear. Rectal ulcers are usually benign (harmless) and don’t cause long-term medical problems. [my.clevelandclinic.org]

Prognosis was largely dependent on accurate diagnosis and management of the underlying disorders. [thedoctorsdoctor.com]

If the underlying disease is improved and hemostasis can be achieved, the prognosis is likely to be good. Hemostasis is therefore extremely important. [webview.isho.jp]

Etiology

TERMINOLOGY Definitions Solitary rectal ulcer syndrome (SRUS) Chronic benign defecation disorder with histologic features of mucosal prolapse ETIOLOGY/PATHOGENESIS Contraction of Sphincter during Defecation Excessive straining → compression of rectal [basicmedicalkey.com]

[…] since not necessarily solitary, ulcerated or rectal) Epidemiology Uncommon (incidence of 1 per 100,000 per year) Usually third and fourth decade More common in women Rarely in children ( Pediatrics 2002;110:e79 ) Sites Usually in rectosigmoid colon Etiology [pathologyoutlines.com]

Major complaints include: feeling of "incomplete emptying of the rectum": tenesmus chronic constipation strenuous defecation rectal bleeding rectal mucus secretions non-specific pelvic pain Etiology Two functional disorders of defecation have been recognized [radiopaedia.org]

The exact etiology is not well understood. One theory is that abnormal rectal evacuation due to paradoxical contraction of the puborectalis muscle may play a role in the etiology of this disease. [saudijgastro.com]

Etiologic classification of colitis was lacking in 59% of the cases interpreted by the reviewers as suggestive or diagnostic of a specific cause. [thedoctorsdoctor.com]

Epidemiology

Definition / general Solitary or multiple ulcerated or polypoid lesions 4 - 10 cm from anal margin Terminology Also called mucosal prolapse syndrome (may be a better term since not necessarily solitary, ulcerated or rectal) Epidemiology Uncommon (incidence [pathologyoutlines.com]

Epidemiology Typically younger patients - average age of presentation ~30 years in one study. [3] Rare. Clinical presentation Usually presents as BRBPR ~ 85% of cases. [3] Abdominal pain present in approx. 1/3. [3] May be very painful. [librepathology.org]

Epidemiology Uncommon but the true incidence is unknown because of under-reporting, especially in the elderly population. [patient.info]

Epidemiology of genital human papillomavirus infections. Epidemiol Rev. 1998;10:122–63. ... 2. Pfenninger JL. Androscopy: a technique for examining men for condyloma. J Fam Pract. 1989;29:286–8. 3. Centers for Disease Control and Prevention. [aafp.org]

Pathophysiology

Pathophysiology and role of biofeedback therapy in solitary rectal ulcer syndrome. Am J Gastroenterol. 2006; 101 (3): 613-8[ DOI ][ PubMed ] [ircmj.com]

Abe A common pathophysiology for full thickness rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer Br J Surg, 3 (1989), pp. 290-295 [15.] A.M. Lessells, J. Swanson Beck, R.A. Burnett, S.R. Howatson, F.D. Lee, K.M. [elsevier.es]

Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies. World Journal of Gastroenterology. 2014;20:738. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921483/. Accessed July 26, 2018. [mayoclinic.org]

The pathophysiology in this case may be similar to that seen in stercoral perforation of the bowel in severely constipated patients [Oakenful and Lambrianides, 2011]. [ncbi.nlm.nih.gov]

Although additional tests are available, they play little role in the patient’s management, but provide insights into the pathophysiology and are useful for research purposes. [abdominalkey.com]

Prevention

Prevention How can you prevent rectal ulcers? It isn’t possible to prevent IBD (a condition that causes rectal ulcers). You can reduce your risk of developing a rectal ulcer by staying hydrated and eating foods that are rich in fiber. [my.clevelandclinic.org]

It is widely used as a second-line medication in the prevention and long-term treatment of angina. [pssjournal.biomedcentral.com]

Stool bulking agents and biofeedback constipation management to prevent paradoxical puborectalis contraction. Topical corticosteroids, salicylates, sucralfate enemas, and biofeedback has been described but experience is limited. [gastroenterologybook.com]

Risk factors for pressure ulcer: suggestions for prevention. Rev Esc Enferm USP. 1999;33(3):279-83. [ Links ] 3. Marin Vivo G, Calixto Rodriguez J, Rodriguez Martinez X. Sistema de control fecal Flexi-Seal FMS. [scielo.br]

Your doctor will give you a sedative to help you relax and prevent any discomfort. Once the medicine takes effect, the doctor will insert a lighted scope called a colonoscope into your anus. [healthline.com]

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