Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition
73 SOLITARY RECTAL ULCER (SRU): A RECOGNIZABLE PEDIATRIC ENTITY.
Solitary rectal ulcer syndrome associated with constipation and abnormal defecation dynamics has been well described in adults, but not in children. The diagnosis and management of this entity remains a significant clinical challenge. We describe 8 patients (6 males and 2 females) at 3 centers recently diagnosed with SRU at a mean age of 11.3 years (range 1-16 years). Presenting symptoms included constipation passage of blood, mucus with in the stool and difficulty with defecation. In 2 subjects, the incorrect diagnosis of ulcerative proctitis was assigned prior to referral. Evaluation included normal CBC/ESR studies, normal stool cultures, normal barium enema, rectal manometry and suction biopsies for ganglion cells. Sigmoidoscopy findings varied from edematous rectal folds, localized proctitis, polypoid lesions and early to well defined rectal ulcers in all patients. Visual inspection or the use of anoscopy documented rectal prolapse in 3 patients. Defecography in an additional 3 patients was normal in 1 but revealed internal rectal prolapse and intussusception in 2 patients. Histology of the mucosa and polypoid lesions revealed edema, inflammation and infiltration of the lamina propria with fibrous tissue or smooth muscle. Treatment with stool softeners or fiber supplements resulted in clinical improvement in 4 patients, including one who had progression of ulcer size at sigmoidoscopy. 3 subjects required surgical correction of the distal intussusception for refractory symptoms with good to excellent results noted.
In summary: (1) the diagnosis of SRU in children should be considered in all patients with constipation and/or rectal bleeding; (2) the final diagnosis is made by classical features on sigmoidoscopy and rectal biopsy; (3) medical therapy and management is challenging with some patients requiring surgical intervention; (4) SRU should be considered in the differential diagnosis of proctitis.
Denver, October 4-5, 1996© Lippincott-Raven Publishers