Anorectal: Solitary Rectal Ulcer Syndrome (SRUS)

Solitary Rectal Ulcer Syndrome (SRUS)

Basics

  • Benign Ulcers or Nodular Rectal Lesions
  • Can Have One, Many or No Lesions
    • “Solitary” is Misleading
  • Most Common Associated Condition: Rectal Prolapse (94%)
  • Most Common Site: Anterior Rectal Wall Above the Anorectal Ring

Symptoms

  • Rectal Bleeding
  • Copious Mucous
  • Unproductive Straining
  • Anal Incontinence
  • Pelvic Pain

Diagnosis

  • Based on Clinical History, Endoscopic & Histologic Findings
  • Biopsy Typically Required (Fibromuscular Obliteration of Lamina Propria)

Treatment

  • Initial Tx: Conservative Management
    • High-Fiber Diet & Stool Softeners
    • Avoid Straining
    • Topical Agents
    • Biofeedback Therapy
  • If Fails: Surgery
    • Concurrent Prolapse: Appropriate Prolapse Procedure
    • No Prolapse Present: Proctectomy or Fecal Diversion

SRUS Errythema 1

SRUS Ulcer 2

References

  1. Abid S, Khawaja A, Bhimani SA, Ahmad Z, Hamid S, Jafri W. The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases. BMC Gastroenterol. 2012 Jun 14;12:72. (License: CC BY-2.0)
  2. Katsanos KH, Sigounas DE, Christodoulou DK, Tsianos EV. Isolated rectal ulcer. Ann Gastroenterol. 2011;24(2):121. (License: CC BY-NC-SA-3.0)