Solitary rectal ulcer syndrome: clinical findings, surgical treatment, and outcomes.
BACKGROUND
Solitary rectal ulcer syndrome (SRUS) is a rare disorder often misdiagnosed as a malignant ulcer. Histopathological features of SRUS are characteristic and pathognomonic; nevertheless, the endoscopic and clinical presentations may be confusing. The aim of the present study was to assess the clinical findings, surgical treatment, and outcomes in patients who suffer from SRUS.


METHODS
A retrospective chart review was undertaken, from January 1989 to May 2005 for all patients who were diagnosed with SRUS. Data recorded included: patient's age, gender, clinical presentation, past surgical history, diagnostic and preoperative workup, operative procedure, complications, and outcomes.


RESULTS
During the study period, 23 patients were diagnosed with SRUS. Seven patients received only medical treatment, and in three patients, the ulcer healed after medical treatment. Sixteen patients underwent surgical treatment. In four patients, the symptoms persisted after surgery. Two patients presented with postoperative rectal bleeding requiring surgical intervention. Three patients developed late postoperative sexual dysfunction. One patient continued suffering from rectal pain after a colostomy was constructed. Median follow-up was 14 (range 2-84) months.


CONCLUSIONS
The results of this study show clearly that every patient with SRUS must be assessed individually. Initial treatment should include conservative measures. In patients with refractory symptoms, surgical treatment should be considered. Results of anterior resection and protocolectomy are satisfactory for solitary rectal ulcer.
Torres
Carlos
C
Department of Colorectal Surgery, Cleveland Clinic Florida, 2950, Cleveland clinic Blvd., Weston, FL 33332, USA.
Khaikin
Marat
M
Bracho
Jorge
J
Luo
Cheng Hua
CH
Weiss
Eric G
EG
Sands
Dana R
DR
Cera
Susan
S
Nogueras
Juan J
JJ
Wexner
Steven D
SD
D000328:Adult; D000368:Aged; D019841:Defecography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014456:Ulcer / Q000601:surgery*
Int J Colorectal Dis. 2001 Aug;16(4):228-33
11515682
Int J Colorectal Dis. 1997;12(5):313-5
9401849
Br J Surg. 1986 Mar;73(3):222-4
3947923
Br J Surg. 1998 Dec;85(12):1617-23
9876062
Pediatrics. 2002 Dec;110(6):e79
12456946
Dis Colon Rectum. 1993 Feb;36(2):146-53
8425418
Dis Colon Rectum. 1995 Oct;38(10 ):1080-3
7555423
Am J Surg Pathol. 1985 Jun;9(6):411-21
4091179
Br J Surg. 1998 Sep;85(9):1246-50
9752869
Gut. 1969 Nov;10(11):871-81
5358578
Br J Surg. 1995 Mar;82(3):314-7
7795993
Curr Treat Options Gastroenterol. 2002 Jun;5(3):231-237
12003718
Aust N Z J Surg. 1995 Feb;65(2):93-7
7857237
World J Surg. 1992 Sep-Oct;16(5):836-40
1462617
Dis Colon Rectum. 1992 Mar;35(3):227-34
1740066
Br J Surg. 1981 Oct;68(10):744-7
7284739
Acta Chir Belg. 2004 Feb;104(1):92-6
15053472
Gastroenterol Clin North Am. 2001 Mar;30(1):199-222
11394031
Gut. 1997 Dec;41(6):817-20
9462216
Br J Surg. 1985 Feb;72(2):131-3
3971120