Solitary Rectal Ulcer Syndrome: A Paediatric Case Report

Abstract

Síndrome da Úlcera Retal Solitária: Relato de um Caso PediátricoPalavras Chave Criança · Doenças do recto · Hemorragia gastrointestinal · Síndrome · Úlcera Resumo Introdução: O Síndrome da Úlcera Retal Solitária (SRUS) é uma doença benigna incomum que afeta predominantemente jovens adultos, sendo rara na população pediátri-ca. Caso Clínico: Rapariga de 12 anos com história de 6 meses de evolução de tenesmo, aumento da frequência defecatória e retorragias com muco. Sem antecedentes de obstipação ou outras queixas. Na observação inicial, o exame físico e o estudo analítico eram normais. O exame bacteriológico e virológico das fezes foi negativo. A colonoscopia realizada revelou uma úlcera única no reto distal, a 6 cm da margem anal. As biópsias confirmaram o diagnóstico de SRUS. Apesar do tratamento conservador, os sintomas persistiram. A defecografia mostrou um pequeno retocelo, sem prolapso da mucosa. Devido à proximidade com o esfíncter anal, não foi efectuado tratamen- KeywordsChild · Gastrointestinal haemorrhage · Rectal diseases · Syndrome · Ulcer Abstract Introduction: Solitary rectal ulcer syndrome (SRUS) is an uncommon benign rectal disease. Mostly young adults are affected, and it is rare in paediatric populations. Clinical Case: We present a 12-year-old girl with a 6-month history of tenesmus, frequent defaecation, and bloody stools with mucus. There was no previous history of constipation or other symptoms. At the first visit, physical examination and routine laboratory test results were normal. A stool examination for bacteria and parasites was negative. Colonoscopy revealed a single ulcer in the distal rectum 6 cm from the anal margin. SRUS was confirmed by biopsy. Despite conservative measures, the symptoms persisted. A defaecation proctography showed a small rectocele with no rectal mucosal prolapse. Because of its proximity to the anal sphincter, no surgical intervention was performed. Conclusion: The present case illustrates how difficult the management of SRUS is. Multicentre studies are needed to establish treatment protocols for children. to cirúrgico. Conclusão: O presente caso ilustra o quão difícil é a abordagem do SRUS. São necessários estudos multicêntricos para estabelecer protocolos de tratamento na idade pediátrica.

Solitary Rectal Ulcer Syndrome in a Teenage Girl: A Case Report

“…The histology of solitary rectal ulcer has a distinct feature including thickening of the mucosal layer with disrupting crypts structure, infiltration of the lamina propria with fibroblasts, muscle and collagen fibers that lead to hypertrophied and disrupted muscularis mucosa which look like fibromuscular obliteration. 8 Our patient's histology report revealed chronic inflammatotry cell infiltration in the lamina propria and surface erosion. The crypts were diamond shaped.…”

“…The youngest reported patient with SRUS was a 1.5-year-old child but the majority of cases are children older than 8 years. 8 The average time from the onset of symptoms to diagnosis is 5 years, ranging from 1.2 to 5.5 years. 8 The average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years).…”

“…8 The average time from the onset of symptoms to diagnosis is 5 years, ranging from 1.2 to 5.5 years. 8 The average time from the onset of symptoms to diagnosis is 3.2 years, ranging from 1.2 to 5 years in children, which is shorter than in adult patients (5 years; range, 3 months to 30 years). 9 It was 2 years in our patient.…”

Solitary Rectal Ulcer Syndrome in Children

“…SRUS is seen mainly in older children (>10 years of age). [7][8][9] The diagnosis of SRUS is based on the findings of manometer and electromyography, clinical features, rectal examination, proctosigmoidoscopy, histological examination, nutritional habits, defecation habit, dynamic MRI, and anorectal functional studies. 4,6 While no symptoms are found in 1/4 of the disease, symptomatic cases typically complain of the feeling of straining during defecation, being in the toilet for a long time, but still not fully emptying.…”

The solitary rectal ulcer syndrome in children: a rare condition. A case report and review

“…Il n'y a pas de protocole ou de consensus thérapeutiques bien définis. Les bases du traitement reposent sur les mesures hygiéno-diététiques, quelques agents pharmaceutiques, biofeedback et parfois la chirurgie (1,15,16). Il faut rassurer l'enfant en âge de comprendre et ses parents et bien expliquer la bénignité de la maladie.…”