A Case of Solitary Rectal Ulcer Syndrome with Characteristic Findings of Evacuation and Magnetic Resonance (MR) Defecography.
- Author:
Hye Kyung SONG
1
;
Seung Jae MYUNG
;
Suk Kyun YANG
;
Jin Hyuk LEE
;
Kyoung Min PARK
;
Hye Sook CHANG
;
In Ja YOON
;
Oh Ryoun KWON
;
Weon Seon HONG
;
Jin Ho KIM
;
Young Il MIN
;
Chang Sik YU
Author Information
1. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. sjm5675@amc.seoul.kr
- Publication Type:Case Report
- Keywords:
Solitary rectal ulcer syndrome;
Evacuation defecography;
MR defecography
- MeSH:
Abdominal Pain;
Adult;
Ataxia;
Biofeedback, Psychology;
Biopsy;
Colonoscopy;
Defecation;
Defecography*;
Hemorrhage;
Humans;
Hyperplasia;
Intussusception;
Mucus;
Muscle Spasticity;
Pelvic Floor;
Rectal Prolapse;
Rectum;
Ulcer*
- From:Korean Journal of Gastrointestinal Motility
2003;9(1):66-69
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Solitary rectal ulcer syndrome is an uncommon, chronic benign condition characterized by rectal bleeding, the passage of mucus, tenesmus and excessive straining during defecation. Occasionally, solitary rectal ulcer syndrome has been reported to be associated with defecation disorder such as pelvic floor dyssynergia, rectal intussusception and rectal prolapse. However, it is ambiguous how these associated defecation disorders contribute to make the rectal ulcer. We report a case of solitary rectal ulcer syndrome suggesting the pathophysiology of rectal ulcer by typical findings of evacuation defecography and MR defecography. A 40-year-old man presented with lower abdominal pain, rectal bleeding, passage of mucus and tenesmus intermittently for the past 4 years. Colonoscopy showed a large geographic and circumferential ulcer at the 10 cm distance from the anal verge. A biopsy revealed fibromuscular proliferation of laminar propria, hyperplasia of crypt and focal superficial ulceration. Finally, he was diagnosed as solitary rectal ulcer syndrome. Evacuation defecography showed paradoxical movement of puborectal sling and unusual invagination of rectal walls during defecation. In addition, rectum showed spastic movement and anterior rectal wall directly merged into posterior rectal wall making a kissing appearance. The invagination of the rectum at evacuation defecography proved to be the rectal wall thickening at MR defecography. After 9 sessions of biofeedback therapy, his defecation symptoms improved. However, ulcer was still observed without interval change.
