Chong VH, Jalihal A
Correspondence: Dr Chong Vui Heng, chongvuih@yahoo.co.uk
ABSTRACT
Introduction Solitary rectal ulcer syndrome (SRUS) is a rare disorder of defaecation and persistence of symptoms is common, particularly bleeding per rectum (BPR). This study assessed the clinical, endoscopical characteristics and predictive profiles for persistent BPR.
Methods 28 patients (14 males) with biopsy-proven SRUS were identified from 1989 to 2003, and the clinical and endoscopical findings were retrospectively reviewed.
Results At presentation, the mean age was 29.5 +/- 16.1 (range ten to 81) years. Common symptoms reported included BPR (86 percent), abdominal pain (36 percent), mucus per rectum (25 percent), straining at defaecation (25 percent), diarrhoea (14 percent) and constipation (14 percent). Digital manual evacuation was reported by 11 percent. 68 percent were anaemic and 57 percent required blood transfusion. Lesions were located anteriorly (38.5 percent), posteriorly (30.7 percent) and circumferentially (31.8 percent). The lesions were multiple (34 percent), ulcerative (64.3 percent) and polypoidal/nodular (32.1 percent). At a mean follow-up of 43.5 +/- 36 months, 64 percent (n=18) had multiple admissions (mean 3.1, range one to 12), mainly for transfusion (mean 7.4 units, range two to 27). There was no difference in clinical responses between patients with polypoidal/nodular or ulcerative lesions (p-value is 0.653). Follow-up endoscopies showed improvement (58 percent), progression (21 percent) and no change (21 percent) in the lesions. Four patients had surgery for concerns of neoplasms (n=2) and persistent BPR (n=2). BPR was persistent in 39 percent. Presence of abdominal pain (p-value is 0.008) and passage of abnormal stool (p-value is 0.002) were predictive of persistent BPR.
Conclusion SRUS occurs predominantly in young patients and despite being a benign condition, morbidity remains a problem. Patients' profiles are predictive of persistent BPR.
Keywords: haematochezia, rectal prolapse, rectal ulcer, solitary rectal ulcer syndrome
Singapore Med J 2006; 47(12): 1063-1068
