Poddar Ujjal, Yachha Surender K, Krishnani Narendra, Kumari Niraj, Srivastava Anshu, Sen Sarma Moinak
Department of Pediatric Gastroenterology.
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Pediatr Gastroenterol Nutr. 2020 Jul;71(1):29-33. doi: 10.1097/MPG.0000000000002680.
Solitary rectal ulcer syndrome (SRUS) is said to be rare in children (largest series so far; 55 in children, 116 in adults). We analyzed our experience to look at its clinical presentations, endoscopic appearance, and treatment outcome in a large cohort of children.
Clinical and endoscopic data were collected between 2000 and 2018. Children (18 years or younger) diagnosed to have SRUS on colonoscopy and confirmed by histopathology were included. All children with SRUS were treated with behavioral modification, bulk laxative. Most with ulcer received steroid enema and some sulfasalazine or sucralfate enema.
The median age of 140 children was 12 (interquartile range [IQR]: 10-14) years, 79% were boys. The median symptom duration was 21 (IQR: 9-36) months. Rectal bleeding was the presenting feature in 131 (93.6%); constipation in 38 (27%); and small, frequent stools in 79 (56%). Most children had features of dyssynergic defecation such as prolonged sitting in the toilet (131, 93.6%), excessive straining (138, 98.6%), a feeling of incomplete evacuation (130, 92.8%), and rectal digitation (71, 50.7%). Rectal prolapse was noted in 24 (17%) cases. Colonoscopy documented rectal ulcer in 101 (72%) [Single: 84]. Over a median follow-up of 6 (IQR: 4-18) months, 27 patients were lost to follow-up and of the remaining 113 cases, 71 (62.8%) showed clinical improvement (healing of ulcer documented in 36/82, 44%).
The majority of cases of SRUS presented in second decade with rectal bleeding and features of dyssynergic defecation. Ulcer was noted in three fourths of cases. The outcome of medical treatment with behavioral modification and local therapy was modest.
孤立性直肠溃疡综合征（SRUS）在儿童中据说较为罕见（迄今为止最大系列研究；儿童55例，成人116例）。我们分析了我们的经验，以观察其在一大群儿童中的临床表现、内镜表现及治疗结果。
收集2000年至2018年期间的临床和内镜数据。纳入在结肠镜检查时诊断为SRUS并经组织病理学证实的18岁及以下儿童。所有SRUS患儿均接受行为矫正、容积性泻药治疗。大多数溃疡患儿接受了类固醇灌肠，部分患儿接受了柳氮磺胺吡啶或硫糖铝灌肠。
140例患儿的中位年龄为12岁（四分位间距[IQR]：10 - 14岁），79%为男孩。中位症状持续时间为21个月（IQR：9 - 36个月）。131例（93.6%）以直肠出血为首发症状；38例（27%）有便秘；79例（56%）有少量、频繁排便。大多数患儿有排便协同失调的表现，如在厕所久坐（131例，93.6%）、过度用力排便（138例，98.6%）、排便不尽感（130例，92.8%）和直肠指诊（71例，50.7%）。24例（17%）出现直肠脱垂。结肠镜检查发现1部（72%）有直肠溃疡[单发：84例]。中位随访6个月（IQR：4 - 18个月），27例失访，其余113例中，71例（62.8%）临床症状改善（82例中有36例溃疡愈合，44%）。
大多数SRUS病例出现在第二个十年，表现为直肠出血和排便协同失调的特征。四分之三的病例发现有溃疡。行为矫正和局部治疗的药物治疗效果一般。
