Clinical presentation of and outcome for solitary rectal ulcer syndrome in children

Abstract

Background and aims: Solitary rectal ulcer syndrome (SRUS) is an uncommon but troublesome and easily misdiagnosed condition of childhood. We have reviewed the presentation and outcome following conservative management of a group of children with SRUS attending a single national paediatric gastrointesinal referral unit.

Methods: Eight children were identified with histology-proven SRUS. Chart review was conducted for relevant history and examination at diagnosis. Patients were contacted to assess success of treatment at the time of follow-up.

Results: Symptoms at presentation included repeated prolonged and ineffectual straining at stool, passage of blood/mucous per rectum, diarrhoea, and constipation. Most children were referred with suspected constipation, diarrhoea, or inflammatory bowel disease. On the basis of retrospective chart review, 7 of 8 children responded well to conservative management (behavioural modification programme involving reduction of time spent straining at defecation). The child failing treatment could not comply with advice because of comorbid autism. Six of the initial responders were available for follow-up. Four were asymptomatic. Two had relapsed and were not compliant with the management programme.

Discussion/conclusions: SRUS can masquerade as more common childhood intestinal conditions such as inflammatory bowel disease or constipation. A biopsy is required for diagnosis, because ulceration may not be apparent at the time of endoscopy. Most patients with SRUS in childhood have a satisfactory outcome using a simple behavioural modification approach. Ongoing follow-up to reinforce behavioural modification is important and may avoid long-term, treatment-resistant disease into adulthood.