Solitary Rectal Ulcer Syndrome : Two Case Reportst

THAW ATCHAI AKARA VIPUTH, M.D.*, PRASIT WATANAPA, M.D., Ph.D., F.R.C.S., F.A.C.S.*, SAMRERNG RATANARAPEE, M.D.**

Affiliation : *Department of Surgery, **Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok I 0700, Thailand.

AbstractOwing to its rarity, solitary rectal ulcer syndrome (SRUS) is often misdiagnosed as malig- nant ulcer, or ulcer in association with inflammatory bowel disease. We present two adult females with anorectal symptoms (i.e. pain, tenesmus and bowel habit changes). Both had normal levels of serum carcinoembryonic antigen. Barium enema revealed irregular mucosa with stricture of the lower rectum. An ulcer, 2.7 em in diameter, was found in one patient but not the other. Rectal biopsy under sigmoidoscopy demonstrated non-specific inflammation, without evidence of malignancy. Because of the intractable symptoms and the inability to discriminate between malignant and benign conditions, exploratory laparotomy was performed, followed by low anterior resection of the rectum. Histological examination of both specimens showed submucosal rectal fibrosis with a non-specific ulceration in one. These findings were compatible with SRUS. The patients' symp- toms improved dramatically after the resection and they remain well, five months and one year after surgery. Awareness of this rare anorectal condition is necessary for appropriate management particularly to avoid unnecessary abdomino-perineal resection.

Keywords : Solitary Rectal Ulcer Syndrome, Case Report

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