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. 2012 Feb;54(2):266-70.
doi: 10.1097/MPG.0b013e318240bba5.

Solitary rectal ulcer syndrome in children and adolescents

Emily R Perito  1 , Elizabeth Mileti, Deepal H Dalal, Soo-Jin Cho, Linda D Ferrell, Marjorie McCracken, Melvin B Heyman
Affiliations

Solitary rectal ulcer syndrome in children and adolescents

Emily R Perito et al. J Pediatr Gastroenterol Nutr. 2012 Feb.

Abstract

Objectives: The aim of this study was to describe the presenting symptoms, endoscopic and histologic findings, and clinical courses of pediatric patients diagnosed with solitary rectal ulcer syndrome (SRUS).

Methods: We describe 15 cases of SRUS diagnosed at our institution during a 13-year period. Cases were identified by review of a pathology database and chart review and confirmed by review of biopsies. Data were collected by retrospective chart review.

Results: Presenting symptoms were consistent but nonspecific, most commonly including blood in stools, diarrhea alternating with constipation, and abdominal/perianal pain. Fourteen of 15 patients had normal hemoglobin/hematocrit, erythrocyte sedimentation rate, and albumin at diagnosis. Endoscopic findings, all limited to the distal rectum, ranged from erythema to ulceration and polypoid lesions. Histology revealed characteristic findings. Stool softeners and mesalamine suppositories improved symptoms, but relapse was common.

Conclusions: SRUS in children presents with nonspecific symptoms and endoscopic findings. Clinical suspicion is required, and diagnosis requires histologic confirmation. Response to present treatments is variable.

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Figures

Figure 1
Figure 1
Endoscopic image of SRUS patient, showing distal rectum on retroflexion. Multiple polypoid lesions surrounded by erythema and inflammatory infiltrates.
Figure 2
Figure 2
Rectal biopsy from the SRUS patient whose endoscopy is shown in Figure 1. Histology (H&E) shows smooth muscle hyperplasia in the lamina propria and surface ulceration with associated acute and chronic inflammatory infiltrates. Crypt architectural changes as well as vascular proliferation and ectasia of superficial mucosa are also present.
Figure 3
Figure 3
Rectal biopsy (H&E) from another SRUS patient showing smooth muscle hyperplasia in the lamina propria and of the muscularis mucosae, as well as crypt architectural distortion with misshapen crypts, mild vascular ectasia of superficial mucosa, and minimal inflammatory infiltrate.
See this image and copyright information in PMC

Comment in

References

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