Clinical presentation of and outcome for solitary rectal ulcer syndrome in children.
ABSTRACT Solitary rectal ulcer syndrome (SRUS) is an uncommon but troublesome and easily misdiagnosed condition of childhood. We have reviewed the presentation and outcome following conservative management of a group of children with SRUS attending a single national paediatric gastrointesinal referral unit.
Eight children were identified with histology-proven SRUS. Chart review was conducted for relevant history and examination at diagnosis. Patients were contacted to assess success of treatment at the time of follow-up.
Symptoms at presentation included repeated prolonged and ineffectual straining at stool, passage of blood/mucous per rectum, diarrhoea, and constipation. Most children were referred with suspected constipation, diarrhoea, or inflammatory bowel disease. On the basis of retrospective chart review, 7 of 8 children responded well to conservative management (behavioural modification programme involving reduction of time spent straining at defecation). The child failing treatment could not comply with advice because of comorbid autism. Six of the initial responders were available for follow-up. Four were asymptomatic. Two had relapsed and were not compliant with the management programme.
SRUS can masquerade as more common childhood intestinal conditions such as inflammatory bowel disease or constipation. A biopsy is required for diagnosis, because ulceration may not be apparent at the time of endoscopy. Most patients with SRUS in childhood have a satisfactory outcome using a simple behavioural modification approach. Ongoing follow-up to reinforce behavioural modification is important and may avoid long-term, treatment-resistant disease into adulthood.
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ABSTRACT: 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.World Journal of Gastroenterology 12/2012; 18(45):6541-5. DOI:10.3748/wjg.v18.i45.6541 · 2.43 Impact Factor