Solitary Rectal Ulcer Syndrome: An Exceptional Entity in the Elderly

Solitary ulcer of the rectum or better the syndrome of solitary rectal ulcer syndrome (SRUS) is a rare benign pathology with a prevalence estimated at 1/100,000 inhabitants. It mainly affects young patients with a maximum incidence between the third and fourth decade of life, but can be seen at any age. It remains exceptional in the elderly with only few sporadic cases in the world literature. We report an original case of SRUS occurring in a 70-year-old man with no particular pathological history, who was explored for rectal bleeding with anal pain that had been evolving for two years. As rare as it is, this entity deserves to be known by any healthcare professional caring for elderly subjects because can sometimes progress unfavorably with severe and even fatal complications such as massive bleeding and perforation.

SOLITARY RECTAL ULCER SYNDROME AND ITS RELATION TO SPECIFIC FOOD

Introduction: SRUS was rst identied as clinical identity in 1969. But the etiology is not known. Anal ssure, IBD, proctagia fugax and malignancy, rectal polyps, hemorrhoids, and infections. Rarely ischemia, trauma and cystic profunda colitis and Stercoral ulcers have to be excluded. Hence a careful history is important. Material and methods: Patients presenting with C/O constipation or straining at stools with difculty in passing motion with associated minimal bleeding per rectum on and off period less than a month were included in the study. All patients were investigated for stool for occult blood, Us abdomen, BMFT, CBP and exible sigmoidoscopy. Results:100 patients presenting with constipation and bleeding PR were investigated. Flexible sigmoidoscopy showed multiple pin point supercial ulcers on the anterior rectal wall without involvement of sigmoid colon. The incidence age group wise was seen very high between 20 to 60 years. M: F ratio 47:53. All were positive for stool for occult blood, negative for IBD and malignancy by biopsy. They responded to dietary changes i.e; veg, non spicy, non fried diet with antibiotic, mesalamine (400mg BD) and lactulose 15ml at bed time. 10 days after the test follow up sigmoidoscopy was found normal and patient asymptomatic even after 3 months. Discussion: The incidence of SRUS has become common irrespective of age and sex. The type of food used by all these patients was found to be more or less similar with majority of them using fast food, fried food, and spicy food. Stoppage of the above mentioned food with specic treatment for 10 days resulted in recovery with normal sigmoidoscopy. Conclusion: SRUS incidence is high in general population due to specic food type and evacuation behavior.