Ejaz Zubair, Khan Shafi U, Rehman Rizwan U, Jibran Muhammad S
Gastroenterology and Hepatology, Medical Teaching Institute Lady Reading Hospital, Peshawar, PAK.
Medicine, District Headquarter Hospital Kohat Develpment Authority, Kohat, PAK.
Cureus. 2023 Feb 21;15(2):e35247. doi: 10.7759/cureus.35247. eCollection 2023 Feb.
Solitary rectal ulcer syndrome (SRUS) is a benign rectal condition associated with defecation disorder that has multifactor pathologies and variable findings on presentation, endoscopy, and histopathology. A diagnostic dilemma with an overlap of differentials and step-wise management that starts with conservative therapies and goes up to repeated surgeries in case of failure of the conservative approach.
This study aims to observe clinical, endoscopic, and histological features of SRUS in patients presenting with lower gastrointestinal bleeding.
The study was conducted at the Department of Gastroenterology, Medical Teaching Institute, Lady Reading Hospital Peshawar from October 2018 to April 2020. After written informed consent, 257 patients (149 males and 108 females) from ages 15 to 70 who presented with lower GI bleeding were included via non-probability convenient sampling. Sociodemographic details were recorded in a pre-designed proforma. A colonoscopy was performed with the Colonoscope CF200 Z, Olympus Tokyo, Japan, and findings were noted. Suspected lesions were magnified, dyed with 0.2% indigo carmine, biopsied from the middle and edges of the ulcer, and sent for histopathology. All data were recorded and analyzed in SPSS-20. The mean with SD was calculated for quantitative variables, and frequency and percentages were calculated for qualitative variables. The chi-square test was used to check the significance, and a p-value of <0.05 was considered statistically significant.
SRUS was found in 17 (6.6%) patients with lower GI bleeding, with a male predominance of 57% (n=11). Perirectal bleeding, constipation, mucous discharge, abdominal pain, and anemia were common clinical findings. Solitary lesions, ulceration, and anterior rectum location were the most common endoscopy findings. Obliterated lamina propria with collagen, ulceration, crypt distortion, and inflammatory infiltrates were common histopathological findings.
SRUS is a benign defecation disorder commonly presenting with lower GI bleeding, constipation, straining, and abdominal pain. It needs a stepwise approach with conservative management, medical management, biofeedback, and surgeries as a last resort.
孤立性直肠溃疡综合征（SRUS）是一种与排便障碍相关的良性直肠疾病，具有多因素病理改变，在临床表现、内镜检查和组织病理学检查中表现各异。这是一个诊断难题，存在多种鉴别诊断的重叠，且治疗需采取逐步推进的方式，首先采用保守治疗，若保守治疗失败则需反复手术。
本研究旨在观察下消化道出血患者中SRUS的临床、内镜及组织学特征。
本研究于2018年10月至2020年4月在白沙瓦市雷丁夫人医院医学教学研究所胃肠病科进行。在获得书面知情同意后，通过非概率方便抽样纳入了257例年龄在15至70岁之间、出现下消化道出血的患者（149例男性和108例女性）。社会人口学细节记录在预先设计的表格中。使用日本东京奥林巴斯CF200 Z型结肠镜进行结肠镜检查，并记录检查结果。对可疑病变进行放大，用0.2%靛胭脂染色，从溃疡中部和边缘取组织进行活检，并送去做组织病理学检查。所有数据均在SPSS-20中记录和分析。对定量变量计算均值和标准差，对定性变量计算频率和百分比。采用卡方检验来检验显著性，p值<0.05被认为具有统计学意义。
在17例（6.6%）下消化道出血患者中发现了SRUS，男性占比57%（n = 11）。直肠周围出血、便秘、黏液排出、腹痛和贫血是常见的临床表现。孤立性病变、溃疡形成以及直肠前部位置是最常见的内镜检查结果。固有层被胶原组织替代、溃疡形成、隐窝扭曲和炎症浸润是常见的组织病理学检查结果。
SRUS是一种常见的良性排便障碍，通常表现为下消化道出血、便秘、排便用力和腹痛。其治疗需要采取逐步推进的方法，首先进行保守治疗、药物治疗、生物反馈治疗，最后才考虑手术治疗。
