Goei R, Baeten C, Janevski B, van Engelshoven J
Department of Radiology, University Hospital Maastricht, University of Limburg, the Netherlands.
AJR Am J Roentgenol. 1987 Nov;149(5):933-6. doi: 10.2214/ajr.149.5.933.
The solitary rectal ulcer syndrome is an uncommon entity consisting of a rectal abnormality caused by straining during defecation and characterized by specific histologic changes. Endoscopy may show single or multiple ulcers or a preulcerative phase consisting of mucosal thickening. Findings on barium enema may be normal or nonspecific, consisting of a thickened valve of Houston, nodularity, and rectal stricture. Pathologic changes consist of replacement of the lamina propria by fibroblasts and smooth muscle fibers with marked hypertrophy of the muscularis mucosae. In five patients with histologically proved solitary rectal ulcer syndrome, defecography was performed to evaluate the accompanying defecation disorder. Two patients showed the spastic pelvic floor syndrome, characterized by failure of relaxation of the pelvic floor musculature during straining. In the remaining three, defecography showed an infolding of the rectal wall toward the rectal lumen increasing gradually to form an intussusception. The results indicate that defecography is useful to show the underlying disorder of defecation in the solitary rectal ulcer syndrome.
孤立性直肠溃疡综合征是一种罕见的病症，由排便时用力导致直肠异常引起，其特征为特定的组织学改变。内镜检查可能显示单个或多个溃疡，或表现为黏膜增厚的溃疡前期。钡剂灌肠检查结果可能正常或不具特异性，包括增厚的休斯顿瓣、结节状改变及直肠狭窄。病理改变包括固有层被成纤维细胞和平滑肌纤维取代，黏膜肌层明显肥厚。对5例经组织学证实为孤立性直肠溃疡综合征的患者进行了排粪造影，以评估伴随的排便障碍。2例患者表现为盆底痉挛综合征，其特征为用力时盆底肌肉组织不能松弛。其余3例排粪造影显示直肠壁向肠腔内折叠，逐渐加重形成肠套叠。结果表明，排粪造影有助于显示孤立性直肠溃疡综合征潜在的排便障碍。
