Solitary Rectal Ulcer Syndrome - A Rare Entity in the Pediatric Population.

Abstract

Objective: To study and correlate the clinicopathological findings of Solitary Rectal Ulcer Syndrome (SRUS) in 10 pediatric patients.

Material and methods: This study is a retrospective study of patients from January 2017 to June 2024. The clinical records were reviewed for details of the clinical presentation, colonoscopic findings, associated local and systemic diseases, and other investigations.

Results: The mean age of presentation was 10±1 years, and the youngest child was 6 years old. The most common clinical presentation was rectal bleeding and a single ulcer on endoscopy. Histological findings included crypt distortion, crypt branching, and fibromuscular obliteration of the lamina propria. Immunohistochemistry (IHC) for Smooth Muscle Actin (SMA) and special staining with Masson Trichrome (MT) were used to highlight fibromuscular areas whenever in doubt.

Conclusion: The pathogenesis of SRUS is not well understood. It may be associated with chronic mucosal and hypoperfusion-induced ischemic injury to the rectal mucosa due to trauma or increased rectal pressure during straining. Solitary rectal ulcer is a misnomer, as the patient may present with multiple or no ulcers. Endoscopy and histopathology help to diagnose SRUS. Timely and correct diagnosis reduces the morbidity associated with this entity.