Solitary Rectal Ulcer Syndrome

16	Solitary Rectal Ulcer Syndrome R. Fleischmann

Definition

Solitary rectal ulcer syndrome describes a solitary ulcer surrounded by normal appearing rectal mucosa.

Clinical Picture

Patients present with tenesmus and a feeling of anal obstruction. Blood and mucus appear in stool.

Diagnosis

Using either a rigid rectoscope or a flexible sigmoidoscope the rectum should be inspected up to the rectosigmoid junction. An ulcer 0.5-2.0 cm in size can usually be found between 6 and 13 cm from the anus on the anterior rectal wall, surrounded by normal appearing mucosa.

Endoscopic diagnostic criteria

flat ulcer with smooth border, usually covered with fibrinous exudate (Figs. 16.1, 16.2).

Endoscopic examination procedure

perianal inspection,

digital examination,

rectoscopy/sigmoidoscopy,

smear from the base of the ulcer,

biopsy.

Causes. Solitary rectal ulcers have various causes, but they are most often caused by rectal or anal prolapse. Full-thickness rectal prolapse—protrusion of the full thickness of the rectal wall through the anal ring—is always an indication for surgical intervention.

Anal prolapse is an eversion of hyperplastic anal corpus cavernosum into the anal lumen. Unlike rectal prolapse, the mucosa has radial folds and a starshaped appearance (Fig. 16.3). The stages in anal prolapse are:

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