Challenges in Differentiating Between Solitary Rectal Ulcer Syndrome and Inflammatory Bowel Disease in the Pediatric Population

Abstract

Solitary rectal ulcer syndrome (SRUS) is a benign rectal disease that is rare in pediatric populations due to its underdiagnosis and misdiagnosis in children. It is often misdiagnosed as malignancy, Crohn's disease, and ulcerative colitis due to its wide and varying clinical presentations. Both SRUS and inflammatory bowel disease (IBD) can present with rectal bleeding, constipation, diarrhea, and abdominal pain. Furthermore, macroscopic ulcers and inflammation can be seen in both diseases, making it difficult to diagnose without a biopsy. We present two cases in the pediatric population whose diagnoses of SRUS were delayed because the symptoms and macroscopic findings initially supported the differential diagnosis of IBD. These cases emphasize the difficulty and importance of differentiating between IBD and SRUS, and should encourage practitioners to include this differential diagnosis earlier on to improve diagnostic accuracy and begin implementing effective treatment. This can eventually decrease overall treatment time, unnecessary surgeries and diagnostic testing, and increase the emotional reassurance of the benign nature of the disease.