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Difference between revisions of "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.<ref name=pmid22697798>{{Cite journal | last1 = Abid | first1 = S. | last2 = Khawaja | first2 = A. | last3 = Bhimani | first3 = SA. | last4 = Ahmad | first4 = Z. | last5 = Hamid | first5 = S. | last6 = Jafri | first6 = W. | title = The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases. | journal = BMC Gastroenterol | volume = 12 | issue = | pages = 72 | month = | year = 2012 | doi = 10.1186/1471-230X-12-72 | PMID = 22697798 }}</ref> | |||
==General== | |||
*Clinically may be suspected to a malignancy - biopsied routinely. | |||
*Mucosal ulceration. | |||
*"Three-lies disease":<ref name=pmid18271667>{{cite journal |author=Crespo Pérez L, Moreira Vicente V, Redondo Verge C, López San Román A, Milicua Salamero JM |title=["The three-lies disease": solitary rectal ulcer syndrome] |language=Spanish; Castilian |journal=Rev Esp Enferm Dig |volume=99 |issue=11 |pages=663–6 |year=2007 |month=November |pmid=18271667 |doi= |url=http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=459864&TO=RVN&Eng=1}}</ref> | |||
# May not be solitary. | |||
# May not be rectal -- can be in left colon. | |||
# 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.<ref name=pmid17139403>{{cite journal |author=Chong VH, Jalihal A |title=Solitary rectal ulcer syndrome: characteristics, outcomes and predictive profiles for persistent bleeding per rectum |journal=Singapore Med J |volume=47 |issue=12 |pages=1063–8 |year=2006 |month=December |pmid=17139403 |doi= |url=http://www.sma.org.sg/smj/4712/4712a7.pdf}}</ref> | |||
*Rare. | |||
===Clinical presentation=== | |||
*Usually presents as [[BRBPR]] ~ 85% of cases.<ref name=pmid17139403/> | |||
*Abdominal pain present in approx. 1/3.<ref name=pmid17139403/> | |||
**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.<ref name=pmid18271667/> | |||
==Microscopic== | |||
Features:<ref name=pmid18271667/><ref name=pmid2091997>{{Cite journal | last1 = Malik | first1 = AK. | last2 = Bhaskar | first2 = KV. | last3 = Kochhar | first3 = R. | last4 = Bhasin | first4 = DK. | last5 = Singh | first5 = K. | last6 = Mehta | first6 = SK. | last7 = Datta | first7 = BN. | title = Solitary ulcer syndrome of the rectum--a histopathologic characterisation of 33 biopsies. | journal = Indian J Pathol Microbiol | volume = 33 | issue = 3 | pages = 216-20 | month = Jul | year = 1990 | doi = | PMID = 2091997 }}</ref> | |||
*Fibrosis of the lamina propria. | |||
*Thickened muscularis mucosa with abnormal extension to the lumen. | |||
*+/-Mucosa ulceration. | |||
*+/-Submucosal fibrosis. | |||
DDx: | |||
*[[Inflammatory pseudopolyp]] (inflammatory polyp). | |||
**Associated with [[inflammatory bowel disease]]. | |||
*[[Rectal prolapse]]. | |||
*Well-differentiated [[colonic adenocarcinoma|adenocarcinoma]]. | |||
==IHC== | |||
*p53 -ve. | |||
**May be used to help exclude adenocarcinoma. | |||
==See also== | |||
*[[Colon]]. | |||
*[[Rectum]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Rectum]]. | |||