Bizarre presentation of solitary rectal ulcer syndrome mimicking rectal malignancy with impending bowel obstruction

Abstract

Solitary rectal ulcer syndrome (SRUS) is a rare benign and chronic rectal disease that has a wide spectrum of clinical presentations with variable endoscopic findings. It mostly occurs between 20 and 29 years of ages and gives a significant female preponderance. A 23-year-old female presented with 2 years history of constipation and bleeding per rectum, with a recent complaint of tenesmus, inability to defecate along with abdominal distention, and vomiting. She was on mesalazine as advised by the gastroenterologist, without improvement. Contrast-enhanced computed tomography (CECT) abdomen showed circumferential poorly enhancing 8 cm rectal mass starting 10 cm from the anal verge with multiple mesorectal lymphadenopathy. Colonoscopy showed hard, ulcerating rectal mass obstructing the lumen, highly suspicious for malignancy. Endoscopic biopsy showed the features suggesting SRUS. However, as the patient had impending colonic obstruction along with the doubtful presence of underlying malignancy, we prepared her for exploratory laparotomy, which revealed a hard midrectum 5 cm × 5 cm × 6 cm mass, so low anterior resection had done with stapled colorectal anastomosis. Paraffin section proved the diagnosis of SRUS. SRUS should always be considered in young patients with malignant-mimicking rectal mass. A differential diagnosis of SRUS should always be kept in mind for mural thickening of the rectum on CT. However, it is important not to miss a diagnosis of rectal cancer over the diagnosis of SRUS.