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Surgical therapy for colitis cystica profunda and solitary rectal ulcer syndrome

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Opinion statement

  • The initial treatment for patients with colitis cystica profunda is aimed at reeducation of bowel habits to avoid straining. Patients are instructed to spend the minimum time on the commode. A highfiber diet with bulk laxatives is recommended. If fiber does not work, polyethylene glycol solutions and surfaceactive stool softeners such as docusate sodium are tried. Conservative therapy resolves most symptoms. Biofeedback is offered to patients who fail dietary therapy.

  • For patients with associated rectal prolapse, an operation designed to correct the intussusception is considered. For fullthickness prolapse (procidentia) a mucosal resection (Delorme) or perineal proctectomy (Altemeier) is recommended. Surgical treatment of internal (occult) prolapse is problematic. If attempted, a resection and suture rectopexy has the most support.

  • In the absence of procidentia, transanal excision may be used in selected patients.

  • If other measures fail, a mucosal sleeve resection with coloanal pullthrough or a diverting colostomy may be considered.

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References and Recommended Reading

  1. Gordon PH: Miscellaneous entities. In Principles and Practice of Surgery for the Colon, Rectum, and Anus. Edited by Gordon PH, Nivatvongs S. St. Louis: Quality Medical Publishing; 1999:1394–1396. A comprehensive summary of CCP.

    Google Scholar 

  2. Valenzuela M, MartinRuiz JL, AlvarezCienfuegos E, et al.: Colitis cystica profunda: imaging diagnosis and conservative treatment. Report of two cases. Dis Colon Rectum 1996, 39:587–590.

    Article  PubMed  CAS  Google Scholar 

  3. Fonde EC, Rodning CB: Gastritis cystica profunda. Am J Gastroenterol 1986, 81:459–464.

    PubMed  CAS  Google Scholar 

  4. Alexis J, Lubin J, Wallack M: Enteritis cystica profunda in a patient with Crohn’s disease. Arch Pathol Lab Med 1989, 113:947–949.

    PubMed  CAS  Google Scholar 

  5. Goodall HB, Sinclair IS: Colitis cystica profunda. J Pathol 1957, 73:33–42.

    Article  Google Scholar 

  6. Madoff RD: Rectal prolapse and intussusception. In Fundamentals of Anorectal Surgery, edn 2. Edited by Beck DE, Wexner SD. London: W B Saunders; 1998:99–114.

    Google Scholar 

  7. Rutter KRP: Solitary rectal ulcer syndrome of the rectum: its relation to mucosal prolapse. In Coloproctology in the Pelvic Floor. Edited by Henry MM, Swash M. London: Butterworths; 1985:282–289.

    Google Scholar 

  8. Keighley MRB, Williams NS: Solitary rectal ulcer syndrome. In Surgery of the Anus, Rectum, and Colon. London: W B Saunders; 1993:720–738.

    Google Scholar 

  9. Green GI, Ramos R, Bannayan GA, McFee AS: Colitis cystica profunda. Am J Surg 1974, 127:749–752.

    Article  PubMed  CAS  Google Scholar 

  10. Rosengren JE, Hildell J, Lindstrom CO, Leandoer L: Localized colitis cystica profunda. Gastrointest Radiol 1982, 7:79–83.

    Article  PubMed  CAS  Google Scholar 

  11. Hulsmans FJ, Tio TL, Reeders JW, Tytgat GN: Transrectal US in the diagnosis of localized colitis cystica profunda. Radiology 1991, 181:201–203.

    PubMed  CAS  Google Scholar 

  12. FeltBersma RJ, Cuesta MA: Rectal prolapse, rectal intussusception, rectocele, and solitary rectal ulcer syndrome. Gastroenterol Clin North Am 2001, 30:199–222. A current, succinct review of SRUS.

    Article  CAS  Google Scholar 

  13. BrandtGradel V, Huibregtse K, Tytgat GNJ: Treatment of solitary rectal ulcer syndrome with high fiber diet and abstention of straining at defecation. Dig Dis Sci 1984, 29:1005–1008.

    Article  Google Scholar 

  14. Martin CJ, Parks TG, Biggard JD: Solitary rectal ulcer syndrome in Northern Ireland 1987–1980. Br J Surg 1981, 68:744–747.

    Article  PubMed  CAS  Google Scholar 

  15. vanden BrandtGradel V, Huibregtse K, Tytgat GN: Treatment of solitary rectal ulcer syndrome with highfiber diet and abstention of straining at defecation. Dig Dis Sci 1984, 29:1005–1008.

    Article  Google Scholar 

  16. Stuart M: Proctitis cystica profunda: incidence, etiology, and treatment. Dis Colon Rectum 1984, 27:153–156.

    Article  PubMed  CAS  Google Scholar 

  17. Malouf AJ, Vaizey CJ, Kamm MA: Results of behavioral treatment (biofeedback) for solitary rectal ulcer syndrome. Dis Colon Rectum 2001, 44:72–76. A report of the longterm results obtained using biofeedback therapy for SRUS. Documents some deterioration with time, but more than 50% of patients can be expected to have ongoing clinical benefit for a median of 3 years.

    Article  PubMed  CAS  Google Scholar 

  18. Binnie NR, Papachrysostomou M, Clare N, Smith AN: Solitary rectal ulcer: the place of biofeedback and surgery in the treatment of the syndrome. World J Surg 1992, 16:836–840.

    Article  PubMed  CAS  Google Scholar 

  19. Vaizey CJ, Roy AJ, Kamm MA: Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback. Gut 1997, 41:817–820.

    Article  PubMed  CAS  Google Scholar 

  20. Guest CB, Reznick RK: Colitis cystica profunda. Review of the literature. Dis Colon Rectum 1998, 32:983–988.

    Google Scholar 

  21. Zargar SA, Khuroo MA, Mahajan R: Sucralfate retention enemas in solitary rectal ulcer. Dis Colon Rectum 1991, 34:455–457.

    Article  PubMed  CAS  Google Scholar 

  22. Whitlow CB, Beck DE, Opelka FG, et al.: Perineal procedures for prolapse. Louisiana State Med J 1997, 149:22–26.

    CAS  Google Scholar 

  23. Berman IR, Manning DH, Dudley Wright K: Anatomic specificity in the diagnosis and treatment of internal rectal prolapse. Dis Colon Rectum 1985, 28:816–826.

    Article  PubMed  CAS  Google Scholar 

  24. Halligan S, Nicholls RJ, Bartram CI: Proctographic changes after rectopexy for solitary rectal ulcer syndrome and preoperative predictive factors for successful outcome. Br J Surg 1995, 82:314–317.

    Article  PubMed  CAS  Google Scholar 

  25. Vaizey CJ, vanden Bogaerde JB, Emmanuel AV, et al.: Solitary rectal ulcer syndrome. Br J Surg 1998, 85:1617–1623. A literature review of all recent articles on SRUS that documents that most patients are helped with dietary and behavioral techniques. Rectopexy is the most common surgical procedure performed and helps approximately 50% of patients; however, it may increase symptoms in those not helped.

    Article  PubMed  CAS  Google Scholar 

  26. Martin JK, Culp CE, Weiland LH: Colitis cystica profunda. Dis Colon Rectum 1980, 23:488–491.

    Article  PubMed  Google Scholar 

  27. Herman AH, Nabseth DC: Colitis cystica profunda, localized, segmental and diffuse. Arch Surg 1973, 106:337–341.

    PubMed  CAS  Google Scholar 

  28. Wayte DM, Helwig EB: Colitis cystica profunda. Am J Clin Pathol 1967, 48:159–169.

    Google Scholar 

  29. Ford MJ, Anderson JR, Gilmour HM, et al.: Clinical spectrum of “solitary ulcer” of the rectum. Gastroenterology 1983, 84:1533–1540.

    PubMed  CAS  Google Scholar 

  30. Guy PJ, Hall M: Colitis cystica of the rectum treated by mucosal sleeve resection and coloanal pullthrough. Br J Surg 1988, 75:289.

    Article  PubMed  CAS  Google Scholar 

  31. Stavorosky M, Weintroub S, Patan J, Rozen P: Successful treatment of a benign solitary rectal ulcer by temporary diverting sigmoidostomy: report of a case. Dis Colon Rectum 1977, 20:347–350.

    Article  Google Scholar 

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  1. Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, 1514 Jefferson Highway, 70121, New Orleans, LA, USA

    David E. Beck MD

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  1. David E. Beck MD
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Beck, D.E. Surgical therapy for colitis cystica profunda and solitary rectal ulcer syndrome. Curr Treat Options Gastro 5, 231–237 (2002). https://doi.org/10.1007/s11938-002-0045-7

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