Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
BMC Gastroenterol. 2012 Jun 14;12:72. doi: 10.1186/1471-230X-12-72.
Solitary rectal ulcer syndrome (SRUS) is an uncommon although benign defecation disorder. The aim of this study was to evaluate the variable endoscopic manifestations of SRUS and its association with other diseases.
All the patients diagnosed with SRUS histologically from January 1990 to February 2011 at The Aga Khan University, Karachi were included in the study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic and histological findings.
A total of 116 patients were evaluated. The mean age was 37.4 ± 16.6 (range: 13-80) years, 61 (53%) of the patients were male. Bleeding per rectum was present in 82%, abdominal pain in 49%, constipation in 23% and diarrhea in 22%. Endoscopically, solitary and multiple lesions were present in 79 (68%) and 33 (28%) patients respectively; ulcerative lesions in 90 (78%), polypoidal in 29 (25%), erythematous patches in 3 (2.5%) and petechial spots in one patient. Associated underlying conditions were hemorrhoids in 7 (6%), hyperplastic polyps in 4 (3.5%), adenomatous polyps in 2(2%), history of ulcerative colitis in 3 (2.5%) while adenocarcinoma of colon was observed in two patients. One patient had previous surgery for colonic carcinoma.
SRUS may manifest on endoscopy as multiple ulcers, polypoidal growth and erythematous patches and has shown to share clinicopathological features with rectal prolapse, proctitis cystica profunda (PCP) and inflammatory cloacogenic polyp; therefore collectively grouped as mucosal prolapse syndrome. This may be associated with underlying conditions such as polyps, ulcerative colitis, hemorrhoids and malignancy. High index of suspicion is required to diagnose potentially serious disease by repeated endoscopies with biopsies to look for potentially serious underlying conditions associated with SRUS.
孤立性直肠溃疡综合征（SRUS）是一种不常见但良性的排便障碍。本研究旨在评估 SRUS 的可变内镜表现及其与其他疾病的关系。
本研究纳入了 1990 年 1 月至 2011 年 2 月期间在卡拉奇阿迦汗大学被组织学诊断为 SRUS 的所有患者。回顾性分析病历以评估患者的临床谱以及内镜和组织学发现。
共评估了 116 例患者。平均年龄为 37.4±16.6（范围：13-80）岁，61 例（53%）为男性。直肠出血 82%，腹痛 49%，便秘 23%，腹泻 22%。内镜下，79 例（68%）患者存在单发和多发病变，33 例（28%）患者存在溃疡性病变、29 例（25%）息肉样病变、3 例（2.5%）红斑斑和 1 例瘀点。相关基础疾病包括 7 例（6%）痔疮、4 例（3.5%）增生性息肉、2 例（2%）腺瘤性息肉、3 例（2.5%）溃疡性结肠炎病史，而结肠腺癌在 2 例患者中观察到。1 例患者曾因结肠癌接受过结肠切除术。
SRUS 在内镜下可表现为多发溃疡、息肉样生长和红斑斑，并且已显示出与直肠脱垂、囊状直肠炎（PCP）和炎性腔隙性息肉具有相似的临床病理特征；因此被归为黏膜脱垂综合征。这可能与息肉、溃疡性结肠炎、痔疮和恶性肿瘤等基础疾病相关。需要高度怀疑可能存在严重疾病，通过反复内镜检查和活检来寻找与 SRUS 相关的潜在严重基础疾病。
