International Journal of Colorectal Disease

, Volume 22, Issue 11, pp 1389–1393 | Cite as

Solitary rectal ulcer syndrome: clinical findings, surgical treatment, and outcomes

  • Carlos Torres
  • Marat Khaikin
  • Jorge Bracho
  • Cheng Hua Luo
  • Eric G. Weiss
  • Dana R. Sands
  • Susan Cera
  • Juan J. Nogueras
  • Steven D. Wexner
Original Article



Solitary rectal ulcer syndrome (SRUS) is a rare disorder often misdiagnosed as a malignant ulcer. Histopathological features of SRUS are characteristic and pathognomonic; nevertheless, the endoscopic and clinical presentations may be confusing. The aim of the present study was to assess the clinical findings, surgical treatment, and outcomes in patients who suffer from SRUS.

Materials and methods

A retrospective chart review was undertaken, from January 1989 to May 2005 for all patients who were diagnosed with SRUS. Data recorded included: patient’s age, gender, clinical presentation, past surgical history, diagnostic and preoperative workup, operative procedure, complications, and outcomes.


During the study period, 23 patients were diagnosed with SRUS. Seven patients received only medical treatment, and in three patients, the ulcer healed after medical treatment. Sixteen patients underwent surgical treatment. In four patients, the symptoms persisted after surgery. Two patients presented with postoperative rectal bleeding requiring surgical intervention. Three patients developed late postoperative sexual dysfunction. One patient continued suffering from rectal pain after a colostomy was constructed. Median follow-up was 14 (range 2–84) months.


The results of this study show clearly that every patient with SRUS must be assessed individually. Initial treatment should include conservative measures. In patients with refractory symptoms, surgical treatment should be considered. Results of anterior resection and protocolectomy are satisfactory for solitary rectal ulcer.


SRUS Solitary rectal ulcer syndrome Surgery 


  1. 1.
    Vaizey CJ, Roy AJ, Kamm MA (1997) Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback. Gut 47:817–820CrossRefGoogle Scholar
  2. 2.
    Beck DE (2002) Surgical therapy for colitis Cystica profunda and solitary rectal ulcer syndrome. Curr Treat Options Gastroenterol 5:231–237CrossRefPubMedGoogle Scholar
  3. 3.
    Haray PN, Morris-Sitff GJ, Foster ME (1997) Solitary rectal ulcer syndrome—an underdiagnosed condition. Int J Colorect Dis 12:313–315CrossRefGoogle Scholar
  4. 4.
    Vaizey CJ, Bogaerde JB, Emmanuel AV et al (1998) Solitary rectal ulcer syndrome. Br J Surg 85:1617–1623CrossRefPubMedGoogle Scholar
  5. 5.
    Marchal F, Bresler L, Brunaud L et al (2001) Solitary rectal ulcer syndrome: a series of 13 patients operated with a mean follow-up of 4.5 years. Int J Colorect Dis 16:228–233CrossRefGoogle Scholar
  6. 6.
    Sitzler PJ, Kamm MA, Nicholls RJ, McKee RF (1998) Long-term clinical outcome of surgery for solitary rectal ulcer syndrome. Br J Surg 85:1246–1250CrossRefPubMedGoogle Scholar
  7. 7.
    Halligan S, Nicholls RJ, Bartram CI (1995) Proctographic changes after rectopexy for solitary rectal ulcer syndrome and preoperative predictive factors for a successful outcome. Br J Surg 82:314–317CrossRefPubMedGoogle Scholar
  8. 8.
    Cruveilhier J (1829) Ulcere chronique du rectum. In: Cruveilher J (ed) Anatomie pathologique du corps humain, vol 2, livre. Maladies du rectum. J. B. Baillierer, Paris, p 4Google Scholar
  9. 9.
    Madigan MR, Morson BC (1969) Solitary ulcer of the rectum. Gut 10:871–881CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Simsek A, Yagci G, Gorgulu S et al (2004) Diagnostic features and treatment modalities in solitary rectal ulcer syndrome. Acta Chir Belg 104:92–96PubMedGoogle Scholar
  11. 11.
    Tjandra JJ, Fazio VW, Church JM et al (1992) Clinical Conundrum of solitary rectal ulcer. Dis Colon Rectum 35:227–234CrossRefPubMedGoogle Scholar
  12. 12.
    Vaizey CJ, Roy AJ, Kamm MA (1997) Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback. Gut 41:817–820CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ertem D, Acars Y, Kotiloglu EK, Pehlivanoglu E (2002) A rare and often unrecognized cause of hematochezia and tenesmus in childhood: solitary rectal ulcer syndrome. Pediatrics 6:1–4Google Scholar
  14. 14.
    Saul H, Sollenberger CL (1985) Solitary rectal ulcer syndrome: its clinical and pathological underdiagnosis. Am J Surg Pathol 9:411–421CrossRefPubMedGoogle Scholar
  15. 15.
    Ho YH, Ho JMS, Parry BR, Goh HS (1995) Solitary rectal ulcer syndrome: the clinical entity and anorectal physiological finding in Singapore. Aust NZ J Surg 65:93–97CrossRefGoogle Scholar
  16. 16.
    Martin CJ, Parks TG, Biggart JD (1981) Solitary rectal ulcer syndrome in Northern Ireland. 1971–1980. Br J Surg 68:744–747CrossRefPubMedGoogle Scholar
  17. 17.
    Van Test WF, Kuijpers JH (1995) Internal rectal intussusception—fact or fancy? Dis Colon Rectum 38:1080–1083CrossRefGoogle Scholar
  18. 18.
    Felt-Bersma RJ, Cuesta MA (2001) Rectal prolapse, rectal intussusception, rectocele and solitary rectal ulcer syndrome. Gastroenterol Clin North Am 30:199–222CrossRefPubMedGoogle Scholar
  19. 19.
    Binnie NR, Papachrysostomou M, Clare N et al (1992) Solitary rectal ulcer: the place of biofeedback and surgery in the treatment of the syndrome. World J Surg 16:836–840CrossRefPubMedGoogle Scholar
  20. 20.
    Tjandra JJ, Fazio VW, Petras RE et al (1993) Clinical and pathologic factors associated with delayed diagnosis in solitary rectal ulcer syndrome. Dis Colon Rectum 36:146–153CrossRefPubMedGoogle Scholar
  21. 21.
    Snooks SJ, Nicholls RJ, Henry MM et al (1985) Electrophysiological and manometric assessment of the pelvis floor in the solitary rectal ulcer syndrome. Br J Surg 72:131CrossRefPubMedGoogle Scholar
  22. 22.
    Nicholls RJ, Simsom NJL (1986) Anteroposterior rectopexy in the treatment of solitary rectal ulcer syndrome without overt rectal prolapse. Br J Surg 73:222–224CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Carlos Torres
    • 1
  • Marat Khaikin
    • 1
  • Jorge Bracho
    • 1
  • Cheng Hua Luo
    • 1
  • Eric G. Weiss
    • 1
  • Dana R. Sands
    • 1
  • Susan Cera
    • 1
  • Juan J. Nogueras
    • 1
  • Steven D. Wexner
    • 1
  1. 1.Department of Colorectal SurgeryCleveland Clinic FloridaWestonUSA

Personalised recommendations