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Solitary rectal ulcer: The place of biofeedback and surgery in the treatment of the syndrome

  • World Progress In Surgery
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Abstract

Thirty-one patients with the solitary rectal ulcer syndrome were studied, the majority of whom presented with fresh blood per rectum and a rectal ulcer, mucorrhoea, or a varying degree of rectal prolapse. Fourteen patients were treated conservatively or with surgery and had a high rate of recurrence of the solitary rectal ulcer syndrome. Seventeen patients were treated with biofeedback for the associated obstructed defecation (anismus) either before or immediately after surgery with a lower recurrence rate. The final symptomatic cure rate was similar in both groups but 15 episodes of recurrence requiring further surgery were encountered in the non-biofeedback group compared to 4 recurrences in the biofeedback group.

Résumé

Trente et un patients ayant un ulcère solitaire du rectum font l'objet de cette étude; la plupart d'entre eux présentaient, associés à des rectorragies et un ulcère, des glaires rectales ou un prolapsus rectal plus ou moins important. Quatorze d'entre eux ont été traités de façon conservative ou par la chirurgie seule: le taux de récidive était élevé. Dix-sept patients ont été traités par biofeedback pour leur anisme soit avant soit après l'acte chirurgical: le taux de récidive était bien moindre. Le taux final de cure symptomatique était similaire dans les deux groupes mais quinze patients ayant une récidive en n'ayant pas eu de biofeedback ont nécessité un acte chirurgical supplémentaire, alors que seulement quatre patients parmi ceux qui avaient eu une thérapie par biofeedback ont récidivé.

Resumen

El síndrome de úlcera rectal solitaira (URS) está comunmente asociado con estreñimineto crónico y con un grado limitado, y generalmente oculto, de prolapso rectal y la secreción de sangre y moco por el recto. La presentación clínica del síndrome de URS sugiere que se trata de una alteración del músculo puborrectal, y la ubicación de la URS al nivel del piso pélvico sugiere que la URS puede ser causada por trauma o presión sobre la mucosa. El reconocimiento del daño causado por una contracción inapropiada del músculo puborrectal en el síndrome de defecación obstruida (anismus), contribuyendo a la oclusión de la unión ano-rectal al hacer el pujo para la defecación, ha llevado al uso de la terapia por bioretroalimentación EMG. Esta persigue corregir la alteración functional “espástica” del anismus que está presente como subfondo de este síndrome. Se estudiaron treínta y un pacientes con el síndrome de URS. La mayoría presentaba sangrado fresco por el recto y una úlcera rectal, mucorrea o un prolapso rectal de grado variable. Catorce pacientes fueron tratados en forma conservadora o con cirugía y exhibieron una elevada tasa de recurrencia del síndrome de URS. Diecisiete pacientes fueron tratados con bioretroalimentación para el cuadro de defecación obstruida antes o inmediatamente después de la cirugía, con una menor tasa de recurrencia. La tasa final de curación sintomática resultó similar en ambos grupos, pero hubo 15 episodios de recurrencia que requirieron cirugía adicional en al grupo en que no se hizo bioretroalimentación, contra cuatro recurrencias en al grupo de bioretroalimentación.

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References

  1. Madigan, M.R.: Solitary ulcer of the rectum. Proc. Soc. Med.57:403, 1964

    Google Scholar 

  2. Haskell, B., Rovner, H.: Solitary ulcer of the rectum. Dis. Colon Rec.8:333, 1965

    Google Scholar 

  3. Wayte, D.M., Helwig, E.D.: Colitis cystica profunda. Am. J. Clin. Pathol.48:159, 1967

    Google Scholar 

  4. Allen, M.S. Jr.: Hamartomatous inverted polyps of the rectum. Cancer19:257, 1966

    PubMed  Google Scholar 

  5. DuBoulay, C.E., Fairbrother, J., Isaacson, P.G.: Mucosal prolapse symdrome: A unifying concept for the solitary rectal ulcer syndrome and related disorders. J. Clin. Pathol.36:1264, 1983

    PubMed  Google Scholar 

  6. Womack, N.R., Williams, N.S., Holmfield, J.H.M., Morrison, J.F.B.: Pressure and prolapse: The cause of solitary rectal ulceration. Gut28:1228, 1987

    PubMed  Google Scholar 

  7. Kawimbe, B.M., Binnie, N.R., Papachrysostomou, M., Smith, A.N.: EMG biofeedback as a domicilliary treatment of anismus. Gut (in press)

  8. Varma, J.S., Smith, A.N.: Anorectal profilometry with the microtransducer. Br. J. Surg.71:867, 1984

    PubMed  Google Scholar 

  9. Varma, J.S., Smith, A.N.: Reproducibility of the proctometrogram. Gut27:288, 1986

    PubMed  Google Scholar 

  10. Bleijenberg, G., Kuijpers, H.C.: Treatment of spastic pelvic floor syndrome with biofeedbac. Dis. Colon Rec.30:108, 1987

    Google Scholar 

  11. Binnie, N.R., Kawimbe, B.M., Papachrysostomou, M., Smith, A.N.: EMG biofeedback as a domicilliary treatment of anismus. Gut30:A714, 1989

  12. Binnie, N.R., Kawimbe, B.M., Papachrysostomou, M., Clare, N., Smith, A.N.: The importance of the orientation of the electrode plates in recording the external anal sphincter EMG by noninvasive anal plug electrodes. Int. J. Color. Dis.6:5, 1991

    Google Scholar 

  13. Kawimbe, B.M., Binnie, N.R., Smith, A.N.: An electromyographically derived (anismus) index in pelvic floor outlet obstruction during defaecation straining. Gut29:A1487, 1988

  14. Madigan, M.R., Morson, B.C.: Solitary ulcer of the rectum. Gut10:871, 1969

    PubMed  Google Scholar 

  15. Armitage, P.: Statistical Methods in Medical Research, Oxford, Blackwell Scientific Publications,

  16. Cruveilheir, J.: Ulcere chronique du rectum. In Anatomie Pathologique du Corps Humain 1870, vol 2, no 55, Maladies du Rectum, Paris, J.B. Balliere, p. 4

  17. Rutter, K.R.P., Riddell, R.H.: Solitary ulcer of the rectum. Clin. Gastroenterol.4:505, 1975

    PubMed  Google Scholar 

  18. Schweiger, M., Alexander-Williams, J.: Solitary ulcer syndrome of the rectum: Its association with occult rectal prolapse. Lancet1:170, 1977

    PubMed  Google Scholar 

  19. Martin, C.J., Parks, T.G., Biggart, J.D.: Solitary rectal ulcer syndrome in Northern Ireland 1971–1980. Br. J. Surg.68:744, 1981

    PubMed  Google Scholar 

  20. Mahieu, P.H.G.: Barium enema and defaecography in the diagnosis and evaluation of the solitary rectal ulcer syndrome. Int. J. Color. Dis.1:85, 1986

    Google Scholar 

  21. Wells, C.: New operation for rectal prolapse. Proc. Soc. Med.52:602, 1959

    Google Scholar 

  22. Preston, D.M., Lennard-Jones, J.E.: Anismus in chronic constipation. Dig. Dis. Sci.30:413, 1985

    PubMed  Google Scholar 

  23. Snooks, S.J., Nicholls, R.J., Henry, M.M., Swash, M.: Electrophysiological and manometric assessment of the pelvic floor in the solitary rectal ulcer syndrome. Br. J. Surg.72:131, 1985

    PubMed  Google Scholar 

  24. Jones, P.N., Lubowski, D.Z., Swash, M., Henry, M.M.: Is paradoxical contraction of the puborectalis muscle of functional importance? Dis. Colon Rec.30:667, 1987

    Google Scholar 

  25. Barnes, P.R.H., Hawley, P.R., Preston, D.M., Lennard-Jones, J.E.: Experience of posterior division of the puborectalis muscle in the management of chronic constipation. Br. J. Surg.72:475, 1985

    PubMed  Google Scholar 

  26. Hallan, R.J., Williams, N.S., Melling, J., Waldron, D.J., Womack, N.R., Morrison, J.F.B.: Treatment of anismus in intractable constipation with Botulinum A toxin. Lancet2:714, 1988

    PubMed  Google Scholar 

  27. Sun, W.M., Read, N.W., Donnelly, T.C., Bannister, J.J., Shorthouse, A.J.: A common pathophysiology for full thickness rectal prolapse, anterior mucosa prolapse and solitary ulcer. Br. J. Surg.76:290, 1989

    PubMed  Google Scholar 

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Authors and Affiliations

  1. University Department of Surgery, Western General Hospital, EH4 2XU, Edinburgh, Scotland

    N. R. Binnie M.D. (R.F.C.S.Ed.), Maria Papachrysostomou M.D., Nicola Clare & A. N. Smith M.D. (F.R.C.S.Ed.)

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  1. N. R. Binnie M.D.
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  2. Maria Papachrysostomou M.D.
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  3. Nicola Clare
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  4. A. N. Smith M.D.
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Binnie, N.R., Papachrysostomou, M., Clare, N. et al. Solitary rectal ulcer: The place of biofeedback and surgery in the treatment of the syndrome. World J. Surg. 16, 836–840 (1992). https://doi.org/10.1007/BF02066979

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