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Solitary Rectal Ulcer Syndrome in Childhood: A Rare, Benign, and Probably Misdiagnosed Cause of Rectal Bleeding. Report of Three Cases

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Diseases of the Colon & Rectum

Solitary rectal ulcer syndrome is an uncommon and often underdiagnosed condition that usually presents with hematochezia, mucous discharge, and tenesmus. Its etiology is unknown but it seems related to excessive straining with defecation. Prolonged efforts force the anterior rectal mucosa into the anal canal with strangulation and appearance of congestion, edema, and ulceration. Histologic findings (fibromuscular obliteration of lamina propria and disorientation of muscle fibers) are characteristic, which helps to differentiate these lesions from other rectal entities. Although solitary rectal ulcer syndrome is rarely reported in children, it must be suspected in patients with rectal discharge of blood and mucus and previous disorders of evacuation. We present three children (aged 9, 10, and 14 years) with solitary rectal ulcer syndrome that had presented with rectal bleeding. A careful inquiry about evacuation habits and a high index of suspicion in children presenting with hematochezia helps to diagnose this possibly unrecognized or misdiagnosed entity in children. Endoscopy and histologic examination confirms this condition.

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References

  1. PN Haray GJ Morris-Stiff ME Foster (1997) ArticleTitleSolitary rectal ulcer syndrome-an underdiagnosed condition Int J Colorectal Dis 12 313–315 Occurrence Handle9401849 Occurrence Handle10.1007/s003840050113 Occurrence Handle1:STN:280:DyaK1c%2FmsFCisw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  2. CJ Vaizey JB Boggaerde Particlevan den AV Emmanuel et al. (1998) ArticleTitleSolitary rectal ulcer syndrome Br J Surg 85 1617–1623 Occurrence Handle9876062 Occurrence Handle10.1046/j.1365-2168.1998.00935.x Occurrence Handle1:STN:280:DyaK1M%2FptFaqsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  3. RJ Felt-Bersma MA Cuesta (2001) ArticleTitleRectal prolapse, rectal intussusception, rectocele and solitary ulcer syndrome Gastroenterol Clin North Am 30 199–222 Occurrence Handle11394031 Occurrence Handle10.1016/S0889-8553(05)70174-6 Occurrence Handle1:STN:280:DC%2BD3Mzis12ltw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. RJ Nicholls (1994) ArticleTitleRectal prolapse and the solitary rectal ulcer syndrome Ann Ital Chir 65 157–162 Occurrence Handle7978755 Occurrence Handle1:STN:280:DyaK2M%2FmvFCmtw%3D%3D

    PubMed  CAS  Google Scholar 

  5. W Wong K Lai TW Shek S Lam (2002) ArticleTitleSelf-inflicted rectal ulcer with exuberant granulation that mimics carcinoma Gastrointest Endosc 55 951–952 Occurrence Handle12024165 Occurrence Handle10.1067/mge.2002.124556

    Article  PubMed  Google Scholar 

  6. MR Madigan BC Morson (1969) ArticleTitleSolitary rectal ulcer of the rectum Gut 10 871–881 Occurrence Handle5358578 Occurrence Handle1:STN:280:DyaE3c%2FlvFSmuw%3D%3D

    PubMed  CAS  Google Scholar 

  7. D Ertem Y Acar EK Karaa E Pehlivanoglu (2002) ArticleTitleA rare and often unrecognized cause of hematochezia and tenesmus in childhood: solitary rectal ulcer syndrome Pediatrics 110 79–82 Occurrence Handle10.1542/peds.110.6.e79

    Article  Google Scholar 

  8. L Rubia ParticleDe la AR Villaespesa M Cebrero et al. (1993) ArticleTitleSolitary rectal ulcer syndrome in children J Pediatr 122 733–736 Occurrence Handle8496752 Occurrence Handle10.1016/S0022-3476(06)80016-8

    Article  PubMed  Google Scholar 

  9. I Kiristioglu E Balkan N Kilic H Dogruyol (2002) ArticleTitleSolitary rectal ulcer syndrome in children Turk J Pediatr 42 55–60

    Google Scholar 

  10. P Godbole I Botterill SJ Newell PM Sagar MD Stringer (2000) ArticleTitleSolitary rectal ulcer syndrome in children J R Coll Surg Edinb 45 411–414 Occurrence Handle11153436 Occurrence Handle1:STN:280:DC%2BD3M7ksFKgug%3D%3D

    PubMed  CAS  Google Scholar 

  11. PA Lingenmann C Coultre ParticleLe J Cox JP Dederding DC Belli (1992) ArticleTitleSolitary rectal ulcer: an unusual cause of rectal bleeding in children Eur J Pediatr 151 658–60 Occurrence Handle10.1007/BF01957567

    Article  Google Scholar 

  12. AV Emmanuel MA Kamm (2001) ArticleTitleLaser Doppler flowmetry as a measure of extrinsic colonic innervation in functional bowel disease Gut 46 212–217 Occurrence Handle10.1136/gut.46.2.212

    Article  Google Scholar 

  13. JJ Tjandra VW Fazio JM Church et al. (1992) ArticleTitleClinical conundrum of solitary rectal ulcer Dis Colon Rectum 35 227–234 Occurrence Handle1740066 Occurrence Handle10.1007/BF02051012 Occurrence Handle1:STN:280:DyaK387lsV2qtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  14. C Siafakas TP Vottler JM Andersen (1999) ArticleTitleRectal prolapse in pediatrics Clin Pediatr (Phila) 38 63–72 Occurrence Handle1:STN:280:DyaK1M7lslClug%3D%3D Occurrence Handle10.1177/000992289903800201

    Article  CAS  Google Scholar 

  15. JJ Tjandra VW Fazio RE Petras et al. (1993) ArticleTitleClinical and pathologic factors associated with delayed diagnosis in solitary rectal ulcer syndrome Dis Colon Rectum 36 146–153 Occurrence Handle8425418 Occurrence Handle10.1007/BF02051170 Occurrence Handle1:STN:280:DyaK3s7ksFOrsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  16. M Kumar AS Puri R Srivastava SK Yachha (1994) ArticleTitleSolitary rectal ulcer in a child treated with local sulfasalazine Indian Pediatr 31 1553–1555 Occurrence Handle7875821 Occurrence Handle1:STN:280:DyaK2M7otFSjtg%3D%3D

    PubMed  CAS  Google Scholar 

  17. PJ Sitzler RJ Kamm Nicholls RF McKee (1998) ArticleTitleLong term clinical outcome of surgery for solitary rectal ulcer syndrome Br J Surg 85 1246–1250 Occurrence Handle9752869 Occurrence Handle10.1046/j.1365-2168.1998.00854.x Occurrence Handle1:STN:280:DyaK1cvitlOqsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  18. A Bonnard JP Mougenot L Ferkdadji O Huot Y Aigrain P Lagausie ParticleDe (2003) ArticleTitleLaparoscopic rectopexy for solitary ulcer of rectum syndrome in a child Surg Endosc 17 1156–1157 Occurrence Handle12728388 Occurrence Handle10.1007/s00464-002-4285-3 Occurrence Handle1:STN:280:DC%2BD2czos1Cgsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  19. V Stoppino R Cuomo P Tonti et al. (2003) ArticleTitleArgon plasma coagulation of hemorrhagic solitary rectal ulcer syndrome J Clin Gastroenterol 37 392–394 Occurrence Handle14564186 Occurrence Handle10.1097/00004836-200311000-00008

    Article  PubMed  Google Scholar 

  20. DV Gopal C Young RM Katon (2001) ArticleTitleSolitary rectal ulcer syndrome presenting with rectal prolapse, severe mucorrhea and eroded polypoid hyperplasia: case report and review of literature Can J Gastroenterol 15 479–483 Occurrence Handle11493953 Occurrence Handle1:STN:280:DC%2BD3MvksFOrug%3D%3D

    PubMed  CAS  Google Scholar 

  21. ME Jarret AV Emmanuel CJ Vaizey MA Kamm (2004) ArticleTitleBehavioral therapy (biofeedback) for solitary rectal ulcer syndrome improves symptoms and mucosal blood flow Gut 53 368–370 Occurrence Handle10.1136/gut.2003.025643

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain

    Javier Martín de Carpi M.D., Pere Vilar M.D. & Vicente Varea M.D.

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  1. Javier Martín de Carpi M.D.
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  2. Pere Vilar M.D.
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  3. Vicente Varea M.D.
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Correspondence to Javier Martín de Carpi M.D..

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Martín de Carpi, J., Vilar, P. & Varea, V. Solitary Rectal Ulcer Syndrome in Childhood: A Rare, Benign, and Probably Misdiagnosed Cause of Rectal Bleeding. Report of Three Cases. Dis Colon Rectum 50, 534–539 (2007). https://doi.org/10.1007/s10350-006-0720-1

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  • DOI: https://doi.org/10.1007/s10350-006-0720-1

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