Solitary Rectal Ulcer Syndrome: Clinical, Endoscopic, and Histopathological Findings in 40 Bangladeshi Children

Abstract

Purpose: Solitary rectal ulcer syndrome (SRUS) is a benign disease of unknown etiology. This study aimed to evaluate the clinical, endoscopic, and histopathological findings of SRUS in Bangladeshi children. Methods: This prospective observational study was conducted at the Department of Pediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, between January 2021 and December 2022. A total of 260 children aged <18 years with rectal bleeding were admitted for a full evaluation, including detailed history taking and colonoscopy. Among them, 40 met the inclusion criteria for SRUS. The collected data contained clinical characteristics and macroscopic and microscopic findings, expressed as numbers and percentages. Results: The mean age of the group was 13.07±2.14 years; male patients comprised 57.5% and female patients 42.5%. Among the 40 children who presented with rectal bleeding, the most common symptoms were straining during defecation (85.0%), followed by constipation (82.5%), sensation of incomplete evacuation (72.5%), mucus passage per rectum (70.0%), tenesmus (57.5%), abdominal pain (45.0%), manual digital evacuation (42.5%), perianal discomfort (37.5%), and diarrhea (22.5%). Colonoscopy revealed that most lesions were located in the rectum (97.6%) and ulcerative (65.9%). The mean distance of the lesions from the anal verge; 6.04±0.91 cm. Histologically, most lesions showed fibromuscular obliteration (95.0%) and crypt distortion (85.0%). Conclusion: Among the 40 children with SRUS who presented with rectal bleeding, straining during defecation was the most common symptom. Single ulcerative lesions in the rectum were the most frequent colonoscopic findings, and the majority showed fibromuscular obliteration and crypt distortion.