Nincheri Kunz M, Renzi F, Kröning K C, Prosperi P, Giovane A, Pampaloni F, Pernice L M
Istituto di Clinica Chirurgica Generale, Università degli Studi, Firenze.
Minerva Chir. 1998 Nov;53(11):919-34.
The solitary rectal ulcer (SRU) is a benign lesion of adults of either sex, which presents with chronic constipation, peculiar defecatory disorders, rectal prolapse and smaller psychological abnormalities. The characteristic appearance of this disease is a "neither being always ulcerate, nor always solitary" lesion, but often with polypoid or granular feature, typically localized in anterior rectal wall, a few inches from anal channel. Distinctive histopathological specimens are localized mucosal distortion, hypertrophic proliferation of muscularis mucosae and obliteration of lamina propria by fibroblasts and muscle fibres from the muscularis mucosae. Very few intermittent or recurrent symptoms are rectal bleeding and mucous discharge with defecations, difficulty of a complete ampullar evacuation and sometimes pelvic or rectoperineal pain. Clinical picture and endoscopic biopsies led to diagnosis. Barium enema, defecography, transrectal ultrasound, manometry and electromyography have an additional role. Medical treatment is performed by high-fiber diet, but biofeedback training is very helpful. Surgical management is as an excisional surgery, as a rectopexy if there is prolapse. Fecal diversion and rectocolic resection are considered only for patients with obstinate and severe symptoms. Even in patients who seem to advocate a surgical approach it is important to heal a dyskinetic puborectalis muscle.
孤立性直肠溃疡（SRU）是一种成年男女均可发生的良性病变，表现为慢性便秘、特殊的排便障碍、直肠脱垂以及较小的心理异常。该病的特征性表现是一种“既不总是溃疡，也不总是孤立”的病变，常具有息肉样或颗粒样特征，典型地位于距肛管几英寸的直肠前壁。独特的组织病理学标本表现为局部黏膜扭曲、黏膜肌层肥厚性增生以及黏膜固有层被来自黏膜肌层的成纤维细胞和肌纤维闭塞。极少出现的间歇性或复发性症状有排便时直肠出血和黏液排出、壶腹完全排空困难，有时还有盆腔或直肠会阴区疼痛。根据临床表现和内镜活检进行诊断。钡剂灌肠、排粪造影、经直肠超声、测压和肌电图检查有辅助作用。内科治疗采用高纤维饮食，但生物反馈训练非常有帮助。手术治疗方式为切除手术，若存在脱垂则行直肠固定术。仅对有顽固和严重症状的患者考虑粪便转流和直肠结肠切除术。即使在似乎主张手术治疗的患者中，治愈运动障碍的耻骨直肠肌也很重要。
