Solitary rectal ulcer syndrome in children: a prospective study of cases from southern Iran

Background Solitary rectal ulcer syndrome (SRUS) is an uncommon rectal disorder that can present with bleeding, passage of mucus, straining during defecation, and a sense of incomplete evacuation. As it is rare, its incidence is uncertain, but has been estimated to be one in 100 000 in adults. A few cases, however, have been reported in pediatric age groups. Patients and Methods During a period of 2.5 years, from September 2003 to February 2006,12 consecutive children with prolonged intermittent fresh blood on the surface of stools or mixed with it were diagnosed with SRUS. All cases were treated initially with sucralfate enema and followed up. Results Nine boys and three girls were studied. The mean age of patients was 9.25 +/- 2.67 years. The mean duration from beginning of symptoms to final diagnosis was 6.4 +/- 6.6 months. All cases had normal growth and none had any evidence of bleeding diathesis, significant anemia, bacterial or parasitic infection, or any other systemic diseases to explain their problem. Seven cases responded to sucralfate enema, one to salicylate enema, one to corticosteroid enema, and two cases became asymptomatic after injection of corticosteroid around and within the ulcers. One patient underwent rectopexy. Conclusion As the clinical presentation varies, the diagnosis requires a high index of suspicion on the part of both the clinician and the pathologist. This entity is not rare in children in our center, which may be due to the traditional method of defecation (in squatting position). Furthermore, we conclude that sucralfate enema is a suitable initial medical treatment for children with SRUS, and that injection of corticosteroid is a new treatment modality that requires further research to establish its efficacy.