Solitary rectal ulcer

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Solitary rectal ulcer is a benign disease of the colorectum.

It is also known as solitary ulcer syndrome of the rectum (abbreviated SUS) and solitary rectal ulcer syndrome.

Mucosal prolapse syndrome may be used as a synonym; however, it encompasses other entities.[1]

General

  • Clinically may be suspected to a malignancy - biopsied routinely.
  • Mucosal ulceration.
  • "Three-lies disease":[2]
  1. May not be solitary.
  2. May not be rectal -- can be in left colon.
  3. May not be ulcerating -- non-ulcerated lesions: polypoid and/or erythematous.

Note: Each of the words in solitary rectal ulcer is a lie.

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.

Treatment:

  • Usually conservative, i.e. non-surgical.
  • Resection - may be done for fear of malignancy.

Gross

  • Classically, anterior or anterolateral wall of the rectum.[2]

Microscopic

Features:[2][4]

  • Fibrosis of the lamina propria.
  • Thickened muscularis mucosa with abnormal extension to the lumen.
  • +/-Mucosa ulceration.
  • +/-Submucosal fibrosis.

DDx:

IHC

  • p53 -ve.
    • May be used to help exclude adenocarcinoma.

See also

References

  1. Abid, S.; Khawaja, A.; Bhimani, SA.; Ahmad, Z.; Hamid, S.; Jafri, W. (2012). "The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases.". BMC Gastroenterol 12: 72. doi:10.1186/1471-230X-12-72. PMID 22697798.
  2. 2.0 2.1 2.2 Crespo Pérez L, Moreira Vicente V, Redondo Verge C, López San Román A, Milicua Salamero JM (November 2007). "["The three-lies disease": solitary rectal ulcer syndrome"] (in Spanish; Castilian). Rev Esp Enferm Dig 99 (11): 663–6. PMID 18271667. http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=459864&TO=RVN&Eng=1.
  3. 3.0 3.1 3.2 Chong VH, Jalihal A (December 2006). "Solitary rectal ulcer syndrome: characteristics, outcomes and predictive profiles for persistent bleeding per rectum". Singapore Med J 47 (12): 1063–8. PMID 17139403. http://www.sma.org.sg/smj/4712/4712a7.pdf.
  4. Malik, AK.; Bhaskar, KV.; Kochhar, R.; Bhasin, DK.; Singh, K.; Mehta, SK.; Datta, BN. (Jul 1990). "Solitary ulcer syndrome of the rectum--a histopathologic characterisation of 33 biopsies.". Indian J Pathol Microbiol 33 (3): 216-20. PMID 2091997.