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Rectal Ulceration


Presentation

  • Abstract 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]
  • In each case, the iatrogenic ulcers presented an unusual appearance and resulted in the performance of inappropriate follow-up studies.[ncbi.nlm.nih.gov]
  • 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]
  • Abstract New clinical aspects of the condition currently known as solitary ulcer of the rectum are presented and various histological phases in its development are described.[ncbi.nlm.nih.gov]
  • 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]

Workup

Multiple Ulcerations
  • 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]
  • Some of them had multiple ulcers and some presented with polyps. The lesions were 7-20 cm from the anal verge. Thus, it is obvious that the designation 'solitary ulcer' is a misleading.[saudijgastro.com]
  • Other findings include multiple ulcers, hyperaemic mucosa or a broad-based polypoidal mass. The underlying aetiology of the condition is poorly understood.[academic.oup.com]
Colonic Ulcer
  • Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells that usually line the colon, then bleed and produce pus.[shafran.net]

Treatment

  • The clinical course of this complication and results of treatment options are unknown.[ncbi.nlm.nih.gov]
  • The ulceration failed to respond to medical treatment but was cured by anterior resection of the rectum. The aetiology is not known.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • For the treatment of Solitary rectal ulcer syndrome there are various herbs which help to get rid from this problem.[alwaysayurveda.net]

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]
  • Prognosis was largely dependent on accurate diagnosis and management of the underlying disorders.[thedoctorsdoctor.com]
  • Predicting the outcome of surgery The results of preoperative manometry do not predict the functional outcome regarding continence, although patients with very low sphincter pressures have a poor prognosis.[abdominalkey.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]
  • The prognosis for elderly patients presenting with rectal prolapse is variable and depends on the nature of any underlying or associated problems and the age and general well-being of the patient.[patient.info]

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 wall[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]
  • Etiology : Two functional disorders of defecation has been recognized: 1. Rectal intussusception. 2. Spastic pelvic floor syndrome. The rectal wall invaginates in the distal portion of the rectal lumen or in the anal canal.[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]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology and role of biofeedback therapy in solitary rectal ulcer syndrome. Am J Gastroenterol. 2006; 101 (3): 613-8[ DOI ][ PubMed ][ircmj.com]
  • Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies. World Journal of Gastroenterology. 2014;20:738. . Accessed July 26, 2018. Solitary rectal ulcer syndrome. Merck Manual Professional Version. .[mayoclinic.org]
  • 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]
  • 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]
  • Solitary rectal ulcer syndrome: clinical features, pathophysiology, diagnosis and treatment strategies. World J Gastroenterol, 20(3), 738-744. doi:10.3748/wjg.v20.i3.738 [doi]. Retrieved from PM:24574747[ijbmc.org]

Prevention

  • 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]
  • Simultaneous obliteration of the deep Douglas space may help prevent symptoms of obstructed defecation.[abdominalkey.com]
  • In this case, a combination of excision biopsy with lifestyle and conservative measures aiming to prevent recurrence was used. In this case, a rare presentation of SRUS in the form of a large polyp was confirmed by histology.[academic.oup.com]
  • 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]
  • However, if a further examination is required, a topical anesthetic will be gently applied to the anus and anal canal to prevent discomfort. Treatment Treatment is highly dependent upon the severity of the anal ulcer.[crssny.com]

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