Characteristic feature of chronic solitary rectal ulcer
|A||Proliferation of smooth muscle lamina propria|
|B||Intraepithelial lymphocyte increase|
|C||Subepithelial collagen bands|
|D||Destruction of crypts|
a. The term solitary rectal ulcer is strictly a misnomer as the lesions may be multiple and ulceration may not necessarily be present.
b. Although any age can be affected it is most common in young adults.
c. The macroscopic appearance is of a red thickened area of rectal mucosa usually with a shallow ulcer in the center.
d. Classically it is positioned on the anterior wall of the rectum opposite the puborectails sling 5-8 cm above the anal verge.
e. Histologically the lamina propia is replaced by collagen and there is fibro muscular replacement if the mucosa.
f. The aetiology is unclear but it is now believed that is de to internal rectal prolapse or intussusception which cause trauma to the rectal wall.
g. Clinically, all patients have difficulty in defecation whit) involves going to the toilet several times a day but only actually defecating once or twice.
h. Usually, there is deep seated perineal pain and blood and mucus are often passed.
i. The diagnosis is made by endoscopy and biopsy.
j. If a rigid sigmoidoscopy is being used, asking the patient to strain down during the procedure may reveal the intussuseception.
k. However, the only accurate way of demonstrating an intussueception is by using defecating proctography.