Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Aug 8, 2016; 5(3): 343-348
Published online Aug 8, 2016. doi: 10.5409/wjcp.v5.i3.343
Solitary rectal ulcer syndrome: Is it really a rare condition in children?
Seyed Mohsen Dehghani, Maryam Bahmanyar, Bita Geramizadeh, Anahita Alizadeh, Mahmood Haghighat
Seyed Mohsen Dehghani, Maryam Bahmanyar, Bita Geramizadeh, Anahita Alizadeh, Mahmood Haghighat, Department of Pediatric Gastroenterology, Gastroenterohepatology Research Center, Shiraz Transplant Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran
Author contributions: All authors equally contributed in this work.
Institutional review board statement: The study was reviewed and approved by the Research Ethics Committee of Shiraz University of Medical Sciences.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Seyed Mohsen Dehghani, MD, Professor, Department of Pediatric Gastroenterology, Gastroenterohepatology Research Center, Shiraz Transplant Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran. dehghanism@sums.ac.ir
Telephone: +98-71-36125849 Fax: +98-71-36474298
Received: February 12, 2016
Peer-review started: February 14, 2016
First decision: March 23, 2016
Revised: March 27, 2016
Accepted: April 20, 2016
Article in press: April 22, 2016
Published online: August 8, 2016
Processing time: 176 Days and 23 Hours
Abstract

AIM: To evaluate the clinicopathologic characteristics of the children with solitary rectal ulcer.

METHODS: Fifty-five children with a confirmed diagnosis of solitary rectal ulcer were studied in a period of 11 years from March 2003 to March 2014. All data were collected from the patients, their parents and medical records in the hospital.

RESULTS: From 55 studied patients, 41 were male (74.5%) and 14 female (25.5%). The mean age of the patients was 10.4 ± 3.7 years and the average time period from the beginning of symptoms to diagnosis of solitary rectal ulcer was 15.5 ± 11.2 mo. The most common clinical symptoms in our patients were rectal bleeding (n = 54, 98.2%) and straining during defecation or forceful defecation (n = 50, 90.9%). Other symptoms were as follows respectively: Sense of incomplete evacuation (n = 34, 61.8%), mucorrhea (n = 29, 52.7%), constipation (n = 14, 25.4%), tenesmus and cramping (n = 10, 18.2%), diarrhea (n = 9, 16.4%), and rectal pain (n = 5, 9.1%). The colonoscopic examination revealed 67.3% ulcer, 12.7% polypoid lesions, 10.9% erythema, 7.3% both polypoid lesions and ulcer, and 1.8% normal. Most of the lesions were in the rectosigmoid area at a distance of 4-6 cm from the anal margin. Finally, 69.8% of the patients recovered successfully with conservative, medical and surgical management.

CONCLUSION: The study revealed that solitary rectal ulcer is not so uncommon despite what was seen in previous studies. As the most common symptom was rectal bleeding, clinicians and pathologists should be familiar with this disorder and common symptoms in order to prevent its complications with early diagnosis.

Keywords: Rectal bleeding; Children; Solitary ulcer; Colonoscopy; Forceful defecation

Core tip: What is known? (1) solitary rectal ulcer is considered a rare condition in children; (2) there is a small number of case report and small case series in pediatric age group in the literature; and (3) this disorder has not been well known in children, so, their symptoms can be confused with other more common diseases. What is new? (1) this study reveals that solitary rectal ulcer is not so uncommon in children; (2) to the best of our knowledge it is the largest pediatric series in the world; and (3) high index of suspicious is needed to think about and diagnosis of this disorder.