Solitary Rectal Ulcer Syndrome in a 12 Year Bangladeshi Boy: an Unusual Cause of Rectal Bleeding
Introduction Solitary rectal ulcer syndrome (SURS) is an benign, rare, rectal disorder in children. In 1829, Cruveilhier described four unusual cases of rectal ulcers. The term "solitary ulcers of the rectum" was used by Lloyd Davis in the late 1930s. The term solitary rectal ulcer syndrome is a misnomer because i) ulcers are found in 40% of patient, others having single or multiple ulcers including hyperemic mucosa to broad based polypoid or mass lesions ii) 20% of patients have a solitary ulcer, other lesions are different in shape and size and iii) may involve the sigmoid colon. Regarding pediatric age group, there are very limited data. From adult study, SRUS is an infrequent, with an estimatedprevalence ofabout 1 in 100000 persons per year. The pathogenesis is incompletely understood. Various factors may be involved in its disease process. Most accepted theories are factors associated with direct trauma or causes of local ischemia. Case Report XX, a 12 year old immunized boy, 5th issue of nonconsanguineous parents, presented with painless fresh per rectal bleeding for last 3 years. Bleeding occur drop by drop after defecation or occasionally mixed with stool with variable amount. He also mentioned about something coming out per rectum for last 1 year (Figure 1) He had no history of abdominal pain, fever, tenesmus, constipation, manual disimpaction of stool, diarrhea, joint pain, bleeding manifestation from other site, contact with tuberculosis patient or family history of colonic polyp. But he had history of feeling of incomplete defecation and prolonged straining during defecation. With these complaints he visited to several physicians and underwent colonoscopy for 3 times. Colonoscopy findings was, mucosa of rectum and sigmoid colon looked granular, loss of vascular pattern, covered with whitish mucous like substances, friable and was diagnosed as a case of ulcerative colitis. Abstract Solitary rectal ulcer syndrome (SRUS) is an uncommon cause of per rectal bleeding in children. Due to it's wide variety of presentation and rarity, it is frequently misdiagnosed as other clinical condition like inflammatory bowel disease, rectal polyp, amoebiasis or malignancy. Here we presenting a case initially misdiagnosed as ulcerative colitis, latter after thorough evaluation diagnosed as a case of SRUS.