by Arieda Gjikopulli, Ritu Walia, David Tuchman
A16 year-old male patient presented with an eight-month history of chronic constipation, and hematochezia. There was no history of abdominal
pain, tenesmus, decreased appetite, weight loss or
diarrhea. Physical examination and routine laboratory
studies were non-contributory. Colonoscopy revealed
a polypoid ulcerated mass 5 cm from the anal verge
(Figure 1). Histology is as shown (Figure 2).
Most likely etiology of the rectal bleeding in this
1. Rectal carcinoma
2. Rectal polyp
3. Solitary rectal ulcer syndrome (SRUS)?
The patient was diagnosed with SRUS and treated
conservatively with a high fiber diet and laxatives.
Clinical course was complicated by persistent symptoms
and rectal prolapse that required surgical excision and
Solitary rectal ulcer syndrome is a chronic benign
inflammatory disorder that predominantly affects young
1 Pediatric literature is limited to case
reports and studies with varying treatment protocols
and outcomes. The term SRUS can be misleading as
ulcers occur only in one fourth of the adults with the
remainder having non-ulcer lesions. These lesions may
be multiple and circumfrential with a polypoid, plaque-like or ulcerated appearance on endoscopy.
1, 2 The
Arieda Gjikopulli, MD, Resident, Department of Pediatrics. Ritu Walia, MD, Department
of Pediatric Gastroenterology. David Tuchman, MD, Department of Pediatric
Gastroenterology. The Herman and Walter Samuleson Children’s Hospital, Baltimore, MD