polypoid variant of SRUS is very rare and may mimic
inflammatory bowel disease, polyps, or carcinoma of
1, 3, 4 Hence misdiagnosis or delay in diagnosis
1, 3, 4 Clinical presentation may include
constipation, rectal bleeding, straining with defecation,
incomplete evacuation of feces, self- digitization and
1, 3, 4 The etiology remains obscure and
may be secondary to excessive straining efforts that force
the anterior rectal mucosa into the anal canal causing
strangulation, edema, and ulceration.
1, 3, 4 Histology is
diagnostic with fibromuscular obliteration of the lamina
propria and disorientation of muscle fibers.
Initial management is conservative and focused
on treating the underlying constipation and behavioral
measures to avoid straining.
1-4 Behavioral modification
remains challenging in pediatric practice.
steroid and sucralfate enemas have been used with
initial improvement of symptoms. However recurrence
4-5 Argon plasma coagulation has been
shown to promote ulcer healing and control bleeding
6 Surgery is indicated in patient’s refractory to
medical therapy and includes rectopexy, local excision
of the ulcer and rarely colostomy.
1, 3, 4
Though there are increasing number of cases
in the pediatric literature, misdiagnosis and a delay
in diagnosis remains common. We emphasize the
importance of maintaining a high degree of suspicion in
children who present with rectal bleeding and obstructed
defecation. Therapeutic experience in children with
SRUS, is limited, with variable treatment protocols and
outcomes. Randomized controlled studies documenting
long-term follow-up to establish optimum treatment in
children are required. n
1. Blakburn C, Mcdermott M, Bo. Clinical presentation and outcome of solitary rectal ulcer syndrome in children. J pediatric
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2. Omar I Saadah, Maram S Al-Hubayshi and Ahmad T Ghanem.
Solitary rectal ulcer syndrome presenting as polypoid mass
lesions in a young girl. World J Gastrointest Oncol 2010 August
15; 2( 8): 332-334 ISSN 1948-5204
3. Dehghani SM, Haghighat M, Imanieh MH, Geramizadeh
B.Solitary rectal ulcer syndrome in children: a prospective study
of cases from southern Iran. Eur J Gastroenterol Hepatol 2008
4. Kumar M, Puri AS, Srivastava R, Yachha SK. Solitary rectal
ulcer in a child treated with local sulfasalazine. Indian Pediatr
1994; 31: 1553-1555
5. Somani SK, Ghosh A, Avasthi G, Goyal R, Gupta P. Healing
of solitary rectal ulcers with multiple sessions of argon plasma
coagulation; Digestive endoscopy : Apr; 22( 2):107-11
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C.S. Pitchumoni, M.D.
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C. S. Pitchumoni, M.D.