Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. Ulcers are only found in 40% of the patients; 20% of t...Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. Ulcers are only found in 40% of the patients; 20% of the patients have a solitary ulcer, and the rest of the lesions vary in shape and size, from hyperemic mucosa to broad-based polypoid. Men and women are affected equally, with a small predominance in women. SRUS has also been described in children and in the geriatric population. Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. This disease has well-described histopathological features such as obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. Diffuse collage deposition in the lamina propria and abnormal smooth muscle fiber extensions are sensitive markers for differ-entiating SRUS from other conditions. However, the etiology remains obscure, and the condition is frequently associated with pelvic floor disorders. SRUS is difficult to treat, and various treatment strategies have been advocated, ranging from conservative management to a variety of surgical procedures. The aim of the present review is to summarize the clinical features, pathophysiology, diagnostic methods and treatment strategies associated with SRUS. (C) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.展开更多
Solitary rectal ulcer syndrome(SRUS) is a benign and chronic disorder well known in young adults and less in children.It is often related to prolonged excessive straining or abnormal defecation and clinically presents...Solitary rectal ulcer syndrome(SRUS) is a benign and chronic disorder well known in young adults and less in children.It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding,copious mucus discharge,feeling of incomplete defecation,and rarely rectal prolapse.SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings.The current treatments are suboptimal,and despite correct diagnosis,outcomes can be unsatisfactory.Some treatment protocols for SRUS include conservative management such as family reassurance,regulation of toilet habits,avoidance of straining,encouragement of a high-fiber diet,topical treatments with salicylate,sulfasalazine,steroids and sucralfate,and surgery.In children,SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases,however,it is being reported more than in the past.This condition in children is benign;however,morbidity is an important problem as reflected by persistence of symptoms,especially rectal bleeding.In this review,we discuss current diagnosis and treatment for SRUS.展开更多
Solitary rectal ulcer syndrome(SRUS) is a rare benign condition, which can mimic many other diseases because of their similarities in clinical, endoscopic and histological features. Sessile serrated adenoma/polyp(SSA/...Solitary rectal ulcer syndrome(SRUS) is a rare benign condition, which can mimic many other diseases because of their similarities in clinical, endoscopic and histological features. Sessile serrated adenoma/polyp(SSA/p) is a premalignant lesion in the colon and rectum. The misdiagnosis of SSA/p in SRUS patients has been noted, but the case of SRUS arising secondarily to SSA/p has been rarely reported. We herein report the case of a 59-year-old man who presented with an ulcerative nodular lesion in the rectum, accompanied by the symptoms of blood and mucus in the feces, diarrhea and constipation. Magnetic resonance imagining revealed thickening of the rectal mucosa-submucosa. Histologically, the lesion was characterized by the hyperplastic lamina propria and diffusely serrated crypts. Further immunohistochemical staining showed the loss of HES1 and MLH1 expression in the epithelial cells in the serrated area. The patient with SRUS had histological changes of SSA/p, suggesting a potential of tumor transformation in certain cases. SRUS uncommonly accompanied by serrated lesions should at least be considered by pathologists and clinicians.展开更多
BACKGROUND Solitary rectal ulcer syndrome(SRUS)is a rare rectal disease with unknown etiology.Data on the genetic background in SRUS is lacking.CASE SUMMARY Here,we report the first case of SRUS in a mother-son relati...BACKGROUND Solitary rectal ulcer syndrome(SRUS)is a rare rectal disease with unknown etiology.Data on the genetic background in SRUS is lacking.CASE SUMMARY Here,we report the first case of SRUS in a mother-son relationship.Gene sequencing was conducted on the whole family,which revealed an inherited CHEK2 p.H371Y mutation.The experiment preliminarily revealed that the CHEK2 mutation did not affect the expression of CHEK2 protein,but affected the function of CHEK2,resulting in the expression level changes of downstream genes such as CDC25A.CONCLUSION SRUS is a genetic susceptibility disease where CHEK2 p.H371Y mutation may play a crucial role in the development and prognosis of SRUS.展开更多
Endoscopic hemorrhoidal band ligation is a well-established nonoperative method for treatment of bleeding internal hemorrhoids(grade 1 to 3). It is a safe and effective technique with a high success rate. Complication...Endoscopic hemorrhoidal band ligation is a well-established nonoperative method for treatment of bleeding internal hemorrhoids(grade 1 to 3). It is a safe and effective technique with a high success rate. Complications with this procedure are uncommon. Although rectal ulceration due to band ligation is a rare complication, it can cause life-threatening hemorrhage especially when patients are on medications which impair hemostasis like aspirin or non steroidal antiinflammatory drugs. We present 2 cases of massive lower gastro-intestinal bleeding in patients who had a band ligation procedure performed 2 wk prior to the presentation and were on aspirin at home. Both the patients were hemodynamically unstable requiring resuscitation. They required platelet and blood transfusions and were found to have rectal ulcers on colonoscopy done subsequently. The rectal ulcers corresponded to the site of band ligation. The use of aspirin by these patients would have caused defects in the hemostasis and may have predisposed them to massive bleeding in the presence of rectal ulcers occurring after the band ligation procedure. Managing aspirin before and after the ligation may be difficult especially since adequate guidelines are unavailable. Stopping aspirin in all the cases might not be safe and the decision should be individualized.展开更多
Solitary rectal ulcer syndrome (SRUS) is a rare condition in children. We report a case of SRUS in an 8-year old Saudi girl who presented with recurrent rectal bleeding,intermittent mucosal prolapse,and passage of muc...Solitary rectal ulcer syndrome (SRUS) is a rare condition in children. We report a case of SRUS in an 8-year old Saudi girl who presented with recurrent rectal bleeding,intermittent mucosal prolapse,and passage of mucus per rectum. Colonoscopy revealed multiple polypoid mass lesions with histopathological features of SRUS. The polypoid variant of SRUS is very rare in children and may be confused with rectal malignant or inflammatory conditions.展开更多
AIM:To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer.METHODS:Fifty-five children with a confirmed diagnosis of solitary rectal ulcer were studied in a period of11 years from...AIM:To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer.METHODS:Fifty-five children with a confirmed diagnosis of solitary rectal ulcer were studied in a period of11 years from March 2003 to March 2014.All data were collected from the patients,their parents and medical records in the hospital.RESULTS:From 55 studied patients,41 were male(74.5%) and 14 female(25.5%).The mean age of the patients was 10.4 ± 3.7 years and the average time period from the beginning of symptoms to diagnosis of solitary rectal ulcer was 15.5 ± 11.2 mo.The most common clinical symptoms in our patients were rectal bleeding(n=54,98.2%) and straining during defecation or forceful defecation(n = 50,90.9%).Other symptoms were as follows respectively:Sense of incomplete evacuation(n = 34,61.8%),mucorrhea(n=29,52.7%),constipation(n=14,25.4%),tenesmus and cramping(n =10,18.2%),diarrhea(n= 9,16.4%),and rectal pain(n= 5,9.1%).The colonoscopic examination revealed 67.3%ulcer,12.7%polypoid lesions,10.9%erythema,7.3%both polypoid lesions and ulcer,and 1.8%normal.Most of the lesions were in the rectosigmoid area at a distance of 4-6 cm from the anal margin.Finally,69.8%of the patients recovered successfully with conservative,medical and surgical management.CONCLUSION:The study revealed that solitary rectal ulcer is not so uncommon despite what was seen in previous studies.As the most common symptom was rectal bleeding,clinicians and pathologists should be familiar with this disorder and common symptoms in order to prevent its complications with early diagnosis.展开更多
Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of defecation. Its management is usually unsatisfactory and responds best to surgery especially when there is rectal prolapse. There is a new report of the...Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of defecation. Its management is usually unsatisfactory and responds best to surgery especially when there is rectal prolapse. There is a new report of the use of Argon plasma coagulation (APC) to enhance healing of these ulcers & control its bleeding in a study involving 16 patients. We involved a larger number of 18 patients in this case series to examine the role of APC in enhancing healing of SRUS & control its bleeding.展开更多
BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man develo...BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy.An ulcer with pulsatile bleeding was found on the lower rectum.Due to massive bleeding,the exact location of the bleeding point was not easy to detect with white light imaging(WLI).Upon switching to RDI,the bleeding point appeared in deeper yellow compared to the surrounding blood.Thus,RDI enabled us for easier recognition of the bleeding point,and hemostasis was achieved successfully.Furthermore,we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI.In our case,the color difference of RDI was greater than that of WLI(9.75 vs 6.61),and RDI showed a better distinguished bleeding point from the surrounding blood.CONCLUSION RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.展开更多
Essential thrombocythemia is classified as a chronic myeloproliferative disorder characterized by the overproduction of platelets stemming from a megakaryocytic clone. The diagnosis primarily relies on bone marrow bio...Essential thrombocythemia is classified as a chronic myeloproliferative disorder characterized by the overproduction of platelets stemming from a megakaryocytic clone. The diagnosis primarily relies on bone marrow biopsy findings and the detection of the JAK2 V617F mutation, after the exclusion of secondary thrombocytosis due to conditions such as inflammation, hemolysis, infection, and iron deficiency. On the other hand, Ulcerative colitis represents an inflammatory disorder of the colon. The diagnosis of ulcerative colitis is established through clinical assessment, endoscopic examination, and histological criteria, without a discernible alternative etiology. The concomitant occurrence of these two conditions is infrequent. We present the case of an 85-year-old patient with a history of essential thrombocythemia who exhibited gastrointestinal symptoms characterized by alternating episodes of diarrhea and constipation. A subsequent colonoscopy accompanied by a biopsy revealed histological features consistent with ulcerative colitis. The patient was administered cytoreductive therapy in combination with mesalazine, resulting in favorable outcomes. Current literature addressing this association is limited, indicating the need for further investigative studies to elucidate the causal relationships between these two pathologies and to achieve improved therapeutic management strategies.展开更多
文摘Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. Ulcers are only found in 40% of the patients; 20% of the patients have a solitary ulcer, and the rest of the lesions vary in shape and size, from hyperemic mucosa to broad-based polypoid. Men and women are affected equally, with a small predominance in women. SRUS has also been described in children and in the geriatric population. Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. This disease has well-described histopathological features such as obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. Diffuse collage deposition in the lamina propria and abnormal smooth muscle fiber extensions are sensitive markers for differ-entiating SRUS from other conditions. However, the etiology remains obscure, and the condition is frequently associated with pelvic floor disorders. SRUS is difficult to treat, and various treatment strategies have been advocated, ranging from conservative management to a variety of surgical procedures. The aim of the present review is to summarize the clinical features, pathophysiology, diagnostic methods and treatment strategies associated with SRUS. (C) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.
文摘Solitary rectal ulcer syndrome(SRUS) is a benign and chronic disorder well known in young adults and less in children.It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding,copious mucus discharge,feeling of incomplete defecation,and rarely rectal prolapse.SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings.The current treatments are suboptimal,and despite correct diagnosis,outcomes can be unsatisfactory.Some treatment protocols for SRUS include conservative management such as family reassurance,regulation of toilet habits,avoidance of straining,encouragement of a high-fiber diet,topical treatments with salicylate,sulfasalazine,steroids and sucralfate,and surgery.In children,SRUS is relatively uncommon but troublesome and easily misdiagnosed with other common diseases,however,it is being reported more than in the past.This condition in children is benign;however,morbidity is an important problem as reflected by persistence of symptoms,especially rectal bleeding.In this review,we discuss current diagnosis and treatment for SRUS.
基金Supported by the National Natural Science Foundation of China,No.81101806Natural Science Foundation of Shanghai,No.17ZR1406500
文摘Solitary rectal ulcer syndrome(SRUS) is a rare benign condition, which can mimic many other diseases because of their similarities in clinical, endoscopic and histological features. Sessile serrated adenoma/polyp(SSA/p) is a premalignant lesion in the colon and rectum. The misdiagnosis of SSA/p in SRUS patients has been noted, but the case of SRUS arising secondarily to SSA/p has been rarely reported. We herein report the case of a 59-year-old man who presented with an ulcerative nodular lesion in the rectum, accompanied by the symptoms of blood and mucus in the feces, diarrhea and constipation. Magnetic resonance imagining revealed thickening of the rectal mucosa-submucosa. Histologically, the lesion was characterized by the hyperplastic lamina propria and diffusely serrated crypts. Further immunohistochemical staining showed the loss of HES1 and MLH1 expression in the epithelial cells in the serrated area. The patient with SRUS had histological changes of SSA/p, suggesting a potential of tumor transformation in certain cases. SRUS uncommonly accompanied by serrated lesions should at least be considered by pathologists and clinicians.
基金This work was supported by the Guangdong Basic and Applied Basic Research Fund,No.2022A1515111193the Guangzhou Science and technology plan project,No.2023A04J0581.
文摘BACKGROUND Solitary rectal ulcer syndrome(SRUS)is a rare rectal disease with unknown etiology.Data on the genetic background in SRUS is lacking.CASE SUMMARY Here,we report the first case of SRUS in a mother-son relationship.Gene sequencing was conducted on the whole family,which revealed an inherited CHEK2 p.H371Y mutation.The experiment preliminarily revealed that the CHEK2 mutation did not affect the expression of CHEK2 protein,but affected the function of CHEK2,resulting in the expression level changes of downstream genes such as CDC25A.CONCLUSION SRUS is a genetic susceptibility disease where CHEK2 p.H371Y mutation may play a crucial role in the development and prognosis of SRUS.
文摘Endoscopic hemorrhoidal band ligation is a well-established nonoperative method for treatment of bleeding internal hemorrhoids(grade 1 to 3). It is a safe and effective technique with a high success rate. Complications with this procedure are uncommon. Although rectal ulceration due to band ligation is a rare complication, it can cause life-threatening hemorrhage especially when patients are on medications which impair hemostasis like aspirin or non steroidal antiinflammatory drugs. We present 2 cases of massive lower gastro-intestinal bleeding in patients who had a band ligation procedure performed 2 wk prior to the presentation and were on aspirin at home. Both the patients were hemodynamically unstable requiring resuscitation. They required platelet and blood transfusions and were found to have rectal ulcers on colonoscopy done subsequently. The rectal ulcers corresponded to the site of band ligation. The use of aspirin by these patients would have caused defects in the hemostasis and may have predisposed them to massive bleeding in the presence of rectal ulcers occurring after the band ligation procedure. Managing aspirin before and after the ligation may be difficult especially since adequate guidelines are unavailable. Stopping aspirin in all the cases might not be safe and the decision should be individualized.
文摘Solitary rectal ulcer syndrome (SRUS) is a rare condition in children. We report a case of SRUS in an 8-year old Saudi girl who presented with recurrent rectal bleeding,intermittent mucosal prolapse,and passage of mucus per rectum. Colonoscopy revealed multiple polypoid mass lesions with histopathological features of SRUS. The polypoid variant of SRUS is very rare in children and may be confused with rectal malignant or inflammatory conditions.
基金financial support was provided by research affairs of Shiraz University of Medical Sciences
文摘AIM:To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer.METHODS:Fifty-five children with a confirmed diagnosis of solitary rectal ulcer were studied in a period of11 years from March 2003 to March 2014.All data were collected from the patients,their parents and medical records in the hospital.RESULTS:From 55 studied patients,41 were male(74.5%) and 14 female(25.5%).The mean age of the patients was 10.4 ± 3.7 years and the average time period from the beginning of symptoms to diagnosis of solitary rectal ulcer was 15.5 ± 11.2 mo.The most common clinical symptoms in our patients were rectal bleeding(n=54,98.2%) and straining during defecation or forceful defecation(n = 50,90.9%).Other symptoms were as follows respectively:Sense of incomplete evacuation(n = 34,61.8%),mucorrhea(n=29,52.7%),constipation(n=14,25.4%),tenesmus and cramping(n =10,18.2%),diarrhea(n= 9,16.4%),and rectal pain(n= 5,9.1%).The colonoscopic examination revealed 67.3%ulcer,12.7%polypoid lesions,10.9%erythema,7.3%both polypoid lesions and ulcer,and 1.8%normal.Most of the lesions were in the rectosigmoid area at a distance of 4-6 cm from the anal margin.Finally,69.8%of the patients recovered successfully with conservative,medical and surgical management.CONCLUSION:The study revealed that solitary rectal ulcer is not so uncommon despite what was seen in previous studies.As the most common symptom was rectal bleeding,clinicians and pathologists should be familiar with this disorder and common symptoms in order to prevent its complications with early diagnosis.
文摘Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of defecation. Its management is usually unsatisfactory and responds best to surgery especially when there is rectal prolapse. There is a new report of the use of Argon plasma coagulation (APC) to enhance healing of these ulcers & control its bleeding in a study involving 16 patients. We involved a larger number of 18 patients in this case series to examine the role of APC in enhancing healing of SRUS & control its bleeding.
文摘BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy.An ulcer with pulsatile bleeding was found on the lower rectum.Due to massive bleeding,the exact location of the bleeding point was not easy to detect with white light imaging(WLI).Upon switching to RDI,the bleeding point appeared in deeper yellow compared to the surrounding blood.Thus,RDI enabled us for easier recognition of the bleeding point,and hemostasis was achieved successfully.Furthermore,we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI.In our case,the color difference of RDI was greater than that of WLI(9.75 vs 6.61),and RDI showed a better distinguished bleeding point from the surrounding blood.CONCLUSION RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.
文摘Essential thrombocythemia is classified as a chronic myeloproliferative disorder characterized by the overproduction of platelets stemming from a megakaryocytic clone. The diagnosis primarily relies on bone marrow biopsy findings and the detection of the JAK2 V617F mutation, after the exclusion of secondary thrombocytosis due to conditions such as inflammation, hemolysis, infection, and iron deficiency. On the other hand, Ulcerative colitis represents an inflammatory disorder of the colon. The diagnosis of ulcerative colitis is established through clinical assessment, endoscopic examination, and histological criteria, without a discernible alternative etiology. The concomitant occurrence of these two conditions is infrequent. We present the case of an 85-year-old patient with a history of essential thrombocythemia who exhibited gastrointestinal symptoms characterized by alternating episodes of diarrhea and constipation. A subsequent colonoscopy accompanied by a biopsy revealed histological features consistent with ulcerative colitis. The patient was administered cytoreductive therapy in combination with mesalazine, resulting in favorable outcomes. Current literature addressing this association is limited, indicating the need for further investigative studies to elucidate the causal relationships between these two pathologies and to achieve improved therapeutic management strategies.
