title: Solitary rectal ulcer syndrome: clinical features, pathophysiology, diagnosis and treatment strategies.
abstract: Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. Ulcers are only found in 40% of the patients; 20% of the patients have a solitary ulcer, and the rest of the lesions vary in shape and size, from hyperemic mucosa to broad-based polypoid. Men and women are affected equally, with a small predominance in women. SRUS has also been described in children and in the geriatric population. Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. This disease has well-described histopathological features such as obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. Diffuse collage deposition in the lamina propria and abnormal smooth muscle fiber extensions are sensitive markers for differentiating SRUS from other conditions. However, the etiology remains obscure, and the condition is frequently associated with pelvic floor disorders. SRUS is difficult to treat, and various treatment strategies have been advocated, ranging from conservative management to a variety of surgical procedures. The aim of the present review is to summarize the clinical features, pathophysiology, diagnostic methods and treatment strategies associated with SRUS.
authors.affiliation: Qing-Chao Zhu, Yu Wang, Department of Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China.
authors.forename: Qing-Chao
authors.initials: QC
authors.lastname: Zhu
authors.affiliation: Qing-Chao Zhu, Yu Wang, Department of Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China.
authors.forename: Rong-Rong
authors.initials: RR
authors.lastname: Shen
authors.affiliation: Qing-Chao Zhu, Yu Wang, Department of Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China.
authors.forename: Huan-Long
authors.initials: HL
authors.lastname: Qin
authors.affiliation: Qing-Chao Zhu, Yu Wang, Department of Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012002:Rectal Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D012007:Rectum / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013577:Syndrome; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*
keywords: Clinical characteristics; Diagnosis; Pathophysiology; Solitary rectal ulcer syndrome; Treatment