Solitary Rectal Ulcer Syndrome
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The solitary rectal ulcer syndrome is a chronic, benign condition, mainly
affecting young adults and characterized by the passage of blood and
mucus, rectal pain, prolonged straining, and, often, the feeling of anal
blockage.
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The rectal lesion consists of one or more benign ulcers or
erosions in the mucosa of the anterior wall of the distal rectum.
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The
diagnosis is usually established by sigmoidoscopy and biopsy.
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Barium
enema, especially double contrast barium enema, may demonstrate signs of
thickened rectal folds, rectal spasm, granularity, ulceration, and pseudopolypoid or pseudotumoral changes.
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The most likely etiology is
mechanical injury to the mucosa from repeated rectal intussusception, self-digitation,
or instrumentation.
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In one study of 43 patients with solitary rectal ulcer syndrome, defecography demonstrated
rectal intussusception in 79%. Of these, 44% had external rectal prolapse.
The partial causative role of rectal intussusception is also supported by
the healing of the rectal lesions after proctopexy.
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Other findings which
may be observed during defecography include rectocele, rectal prolapse,
abnormal perineal descent, and puborectalis muscle dysfunction.
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