SOLITARY ULCER SYNDROME
- It is mainly thickening and disorganisation of muscularis mucosa with superficial ulceration.
- It is usually 4–12 cm from the anal verge in the anterior wall of the rectum. But often can occur in sigmoid colon.
- Attempt to defaecate in the closed pelvic floor causes funneling of the rectum and descent of the anterior rectal wall. Raised intrarectal pressure and hidden intussusception is the cause. It is often seen in sexual abused individuals. Often typical crater like ulcer is seen/felt on the anterior rectum. Chronic ischaemia at that point may be the cause.
- In 30% cases, there are multiple ulcers.
- Often there will be inflammation and induration of the area without an ulcer.
Presentations are:- Common in young females, constipation, bleeding, mucosal prolapse, chronic pain in the anal canal, incontinence. But sphincter tone on rectal examination is usually normal.
Investigations: Defaecography shows nonrelaxing persistent puborectalis impression waves. EMG shows decreased electrical activity. Colonoscopy should be done to rule out other conditions like neoplasm, ulcerative colitis. Colonic transit time shows rapid filling of the rectum but delayed clearance of 7 days from the rectum.
- Condition is commonly associated with rectal prolapse.
- Differential diagnosis are carcinoma, tuberculosis, ulcerative colitis.
- High fibre diet.
- Treatment for rectal prolapse.
- Avoid surgical excision in solitary ulcer syndrome as much as possible.
The medicines that can be thought of use are: -
- Argentum nit
- Kali bi
- Nitric acid