title: Solitary rectal ulcer syndrome: A single-center case series.
abstract: OBJECTIVE
  Solitary rectal ulcer syndrome (SRUS) is a benign, chronic defecation disorder with varied presentations. The aim of this study is to summarize the clinical features, endoscopic findings, histological appearance, and treatment strategies associated with SRUS.
  
  
  METHODS
  This is a retrospective study of all patients diagnosed with SRUS at the King Faisal Specialist Hospital and Research Centre in Riyadh from January 2003 to December 2013. Cases were identified using the Department of Pathology database. Data were obtained from medical records that included clinical manifestation, endoscopic findings, and histopathological features.
  
  
  RESULTS
  Twenty patients were identified. The mean age was 42.5 years (±18.5) and 55% were females. Most of the patients presented with bleeding per rectum (85%), constipation (75%), and straining (50%), with a mean symptom duration of 26.7 months. The most common associated factors identified were constipation (75%), history of rectal surgery (25%), digital rectal manipulation (20%), and rectal prolapse (20%). Endoscopic findings included a single ulcer (50%) and multiple ulcers (30%); 55% had a polypoidal appearance. On histopathology, there was surface ulceration (95%), fibrosis of the lamina propria (60%), distorted architecture (55%), and muscle hypertrophy with increased mucin production (50%). Patients were treated conservatively and none required surgery.
  
  
  CONCLUSIONS
  SRUS is a rare disorder with variable clinical presentations. Stool softeners, a high fiber diet in addition to topical mesalamine, and biofeedback proved to be effective in this patient population.
authors.affiliation: Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Abdulaziz I
authors.initials: AI
authors.lastname: AlGhulayqah
authors.affiliation: Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Ehab H
authors.initials: EH
authors.lastname: Abu-Farhaneh
authors.affiliation: Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Fahad I
authors.initials: FI
authors.lastname: AlSohaibani
authors.affiliation: Department of Medicine, Division of Gastroenterology, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Majid A
authors.initials: MA
authors.lastname: Almadi
authors.affiliation: Department of Pathology, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Hadeel M
authors.initials: HM
authors.lastname: AlMana
mesh_terms: D000328:Adult; D003248:Constipation / Q000453:epidemiology*; D019468:Disease Management; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000150:complications / Q000473:pathology*; D012189:Retrospective Studies; D012529:Saudi Arabia; D014456:Ulcer / Q000150:complications / Q000473:pathology*