Abstract
Prolapse of the large intestinal mucosa occurs in various situations including at the margin of a colostomy, the apex of hemorrhoids protruding outside the anus, and in the context of diverticular disease. However the best known sites of mucosal prolapse are the anterior wall of the rectum where it gives rise to the solitary ulcer syndrome and the anorectal junction resulting in a peculiar polyp called “cloacogenic polyp.” These are both benign conditions. Common clinical symptoms are constipation and/or red blood loss per annum. The endoscopy of the solitary ulcer can show a variable picture of erythema, a shallow ulcer, or even a polypoïd lesion. The histology is characteristic. The mucosa around the solitary ulcer shows crypt distortion, reactive epithelial cells, and typical fibromuscular obliteration of the lamina propria. Inflammation is usually mild. A “cloacogenic polyp” appears as a villiform tumor mass at the anorectal junction and has a great potential to be confused with other polyps such as adenomas or even carcinoma. It is important to recognize these lesions in order to avoid the morbidity and mortality associated with major surgery (misdiagnosis of neoplasia) or the side effects of long-term medical treatment.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abid S, Khawaja A, Bhimani SA, et al. The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases. BMC Gastroenterol. 2012;12:72.
Ertem D, Acar Y, Karaa EK, Pehlivanoglu E. A rare and often unrecognized cause of hematochezia and tenesmus in childhood: solitary rectal ulcer syndrome. Pediatrics. 2002;110(6):e79.
Sharara AI, Azar C, Amr SS, et al. Solitary rectal ulcer syndrome: endoscopic spectrum and review of the literature. Gastrointest Endosc. 2005;62:755–62.
Li SC, Hamilton SR. Malignant tumors in the rectum simulating solitary rectal ulcer syndrome in endoscopic biopsy specimens. Am J Surg Pathol. 1998;22:106–12.
Ball CG, Dupre MP, Falck V, et al. Sessile serrated polyp mimicry in patients with solitary rectal ulcer syndrome: is there evidence of preneoplastic change? Arch Pathol Lab Med. 2005;129:1037–40.
Dehgani SM, Haghighat M, Imanieh MH, Geramizadeh B. Solitary rectal ulcer syndrome in children: a prospective study of cases from southern Iran. Eur J Gastroenterol Hepatol. 2008;20:93–5.
Al-Brahim N, Al-Awadhi N, Al-Enezi S, et al. Solitary rectal ulcer symdrome: a clinicopathological study of 13 cases. Saudi J Gastroenterol. 2009;15:188–92.
Torres C, Khaikin M, Bracho J, et al. Solitary rectal ulcer syndrome: clinical findings, surgical treatment, and outcomes. Int J Color Dis. 2007;22:1389–93.
Vaizey CJ, Van den Bogaerde JB, Emmanuel AV, et al. Solitary rectal ulcer syndrome. Br J Surg. 1998;85:1617–23.
Madigan MR, Morson BC. Solitary ulcer of the rectum. Gut. 1969;10:871–81.
Warren BF, Dankwa EK, Davies JD. Diamond–shaped crypts and mucosal elastin: helpful diagnostic features in biopsies of rectal prolapse. Histopathology. 1990;17:129–34.
Tendler DA, Aboudola S, Zacks JF, et al. Prolapsing mucosal polyps: an underrecognized form of colonic polyp. A clinicopathological study of 15 cases. Am J Gastroenterol. 2002;97:370–6.
Londsdale RN. Microvascular abnormalities in the mucosal prolapsed syndrome. Gut. 1993;34:106–9.
Singh B, Mortensen NJ, Warren BF. Histopathological mimicry in mucosal prolapse. Histopathology. 2007;50:97–102.
Bass J, Soucy P, Walton M, et al. Inflammatory cloacogenic polyps in children. J Pediatr Surg. 1995;30:585.
Campbell AP, Cobb CA, Chapman RW, et al. Cap polyposis: an unusual cause of diarrhoea. Gut. 1993;34:562–4.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Jouret-Mourin, A., Leo, M., Geboes, K. (2018). Mucosal Prolapse Syndrome. In: Jouret-Mourin, A., Faa, G., Geboes, K. (eds) Colitis. Springer, Cham. https://doi.org/10.1007/978-3-319-89503-1_16
Download citation
DOI: https://doi.org/10.1007/978-3-319-89503-1_16
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-89502-4
Online ISBN: 978-3-319-89503-1
eBook Packages: MedicineMedicine (R0)