Garrigues J M, Nicaud P
Centre des Maladies de l'Appareil Digestif, Service de Proctologie, Montpellier.
Ann Chir. 1994;48(2):140-9; discussion 149-50.
In line with the literature, the authors consider that solitary ulcer of the rectum, either isolated, multiple or histological, like suspended proctitis, inverted hamartomatous polyp, deep cystic colitis, is a complication of rectal prolapse, which usually shares the same clinical symptoms. Solitary ulcer of the rectum is generally discovered on proctoscopy and is due to the strain exerted on the rectal mucosa by 2 opposing forces:violent effort of defecation against an anal and/or perineal obstruction. The reduction of these pressure and counterpressure forces with age and progressive alteration of the pelvic floor accounts for the progression of acute lesions towards chronic or attenuated lesions or even complete resolution. The therapeutic strategy should therefore decrease trauma by facilitating defecation by a combination of hygiene and dietary advice and biofeedback retraining, and surgical reduction of the anal obstruction and prolapse and correction of any perineal insufficiency.
与文献一致，作者认为直肠孤立性溃疡，无论是孤立性、多发性还是组织学上的，如悬浮性直肠炎、倒置性错构瘤性息肉、深部囊性结肠炎，都是直肠脱垂的并发症，通常具有相同的临床症状。直肠孤立性溃疡一般在直肠镜检查时发现，是由于两种相反力量对直肠黏膜施加的压力所致：排便时对抗肛门和/或会阴梗阻的剧烈用力。随着年龄增长以及盆底的逐渐改变，这些压力和反压力的降低导致急性病变向慢性或减轻的病变发展，甚至完全消退。因此，治疗策略应通过卫生和饮食建议以及生物反馈再训练相结合来促进排便，减少创伤，手术减轻肛门梗阻和脱垂，并纠正任何会阴功能不全。
