Korean J Gastroenterol.  2024 Jan;83(1):17-22. 10.4166/kjg.2023.093.

Rare Cause of Hematochezia in Children: Solitary Rectal Ulcer, Single Center Experience

• Varol F
• Güngör
• Selimoğlu MA
• Şamdancı E

• KMID: 2552238
• DOI: http://doi.org/10.4166/kjg.2023.093

Abstract

Background/Aims
Solitary rectal ulcer syndrome (SRUS) can be overlooked, diagnosed late, or misdiagnosed, particularly in childhood. This study reviewed the 13-year experience of the authors’ institution to increase clinicians' awareness of SRUS in the presence of symptoms. This paper reports the endoscopic and histopathological findings in children presenting with hematochezia.
Methods
The clinical and laboratory findings of 22 patients diagnosed with biopsy-proven SRUS in the authors’ clinic between 2007 and 2020 were evaluated retrospectively.
Results
The mean age at diagnosis was 12.5±2.6 years, and 59.1% of the patients were male. The median time of diagnosis was 24 months. A single ulcer lesion was found by colonoscopy in 18 patients (81.8%), two ulcers in two patients (9%), and more than two ulcers in two patients (9%). The pathology reports of all biopsies taken from the lesions were consistent with a solitary rectal ulcer. In the first stage, the treatment was started with toilet training, a high-fiber diet, and laxatives. In 11 patients (50%) who did not respond to the initial treatment, a 5-ASA enema was added. A glucocorticoid enema was added to treatment in five patients (22%) whose complaints did not regress despite this treatment. Clinical remission was achieved in five of the patients (18.1%). The time to diagnosis was significantly shorter in those in remission than those not in remission (p=0.04).
Conclusions
This study is the first large series on Turkish children. An increased awareness of SRUS in children will increase the rate of early diagnosis and treatment, allowing remission in more patients.

Keyword

Children; Hematochezia; Solitary; Rectal; Ulcer

Figure

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  Fig. 1 Flow chart of patient selection.

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  Fig. 2 Colonoscopic findings: Single ulcer located in front of the anorectal junction.

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  Fig. 3 Histopathologic findings. (A) Rectal mucosal fragment with ulcerated surface. H&E stain ×4. (B) Increased connective tissue, smooth muscle proliferation and crypt loss in the lamina propria. H&E stain ×10.

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