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Solitary Rectal Ulcer Syndrome in Children and Adolescents

Perito, Emily R.*; Mileti, Elizabeth*; Dalal, Deepal H.*; Cho, Soo-Jin; Ferrell, Linda D.; McCracken, Marjorie*; Heyman, Melvin B.*

Journal of Pediatric Gastroenterology and Nutrition: February 2012 - Volume 54 - Issue 2 - p 266–270
doi: 10.1097/MPG.0b013e318240bba5
Original Articles: Gastroenterology

Objectives: The aim of this study was to describe the presenting symptoms, endoscopic and histologic findings, and clinical courses of pediatric patients diagnosed with solitary rectal ulcer syndrome (SRUS).

Methods: We describe 15 cases of SRUS diagnosed at our institution during a 13-year period. Cases were identified by review of a pathology database and chart review and confirmed by review of biopsies. Data were collected by retrospective chart review.

Results: Presenting symptoms were consistent but nonspecific, most commonly including blood in stools, diarrhea alternating with constipation, and abdominal/perianal pain. Fourteen of 15 patients had normal hemoglobin/hematocrit, erythrocyte sedimentation rate, and albumin at diagnosis. Endoscopic findings, all limited to the distal rectum, ranged from erythema to ulceration and polypoid lesions. Histology revealed characteristic findings. Stool softeners and mesalamine suppositories improved symptoms, but relapse was common.

Conclusions: SRUS in children presents with nonspecific symptoms and endoscopic findings. Clinical suspicion is required, and diagnosis requires histologic confirmation. Response to present treatments is variable.

*Department of Pediatrics

Department of Pathology, University of California, San Francisco, CA.

Address correspondence and reprint requests to Emily R. Perito, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, 500 Parnassus Ave, MU 408-East, Box 0136, San Francisco, CA 94143-0136 (e-mail:

Received 29 April, 2011

Accepted 4 October, 2011

Partial support for this work is from NIH Grants DK060617 and DK007762.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN