modalities and outcome of different treatment strategies of patients with solitary rectal ulcer
syndrome (SRUS) and consisted of full investigations, including proctosigmoidoscopy for
patients presenting a picture suggestive of SRUS. Selected patients underwent
proctosigmoidoscopy and biopsy; proctography for assessment of anorectal angle (ARA) and the
extent of perincal descent (PD); anorectal manometric measurement of resting and maximum
squeeze anal pressure (RSP & MSP), functional anal canal length (FACL) and maximum
tolerated rectal volume (MTRV). Patients were categorized into two groups: Group A (SRUS
associated with rectal prolapse,.RP) and Group B (SRUS not associated with RP).. Patients were
initially treated with conservative measures and followed-up monthly for 3-9 months,
biofeedback training for patients with inappropriate contractions of puborectalis muscle.
Patients with failed conservative treatment underwent surgical treatment according to the
status. There were 12 patients with SRUS; 7 patients with RP (5 females & 2 males) and 5
patients' without RP (3 females & 2 males). Straining at defecation, rectal bleeding, tenesmus
and constipation were the most common complaints. Solitary ulcers were detected in 7 and
multiple ulcers in 5 patients, there were 8 anterior and 4 right antrolateral ulcers. Group A
ulcers were significantly wider than group B ulcers. Biopsy examination detected colitis cystica
profounda in one patient in group A. There was a significant PD with significant increase in
ARA in group A, while other manometric measurements were significantly decreased compared
to group B. Seven patients showed partial improvement on conservative treatment and
biofeedback training and 2 patients in group Bdiad healed ulcer. Success was manifested as
significant reduction of subjective symptoms with a significant improvement of ARA at straining
in patients with paradoxical |
