A Case Report of Radiation Proctitis Treated with Shiunko Enema / 日本東洋医学雑誌

We report a case of a 57-year-old woman with radiation proctitis (RP) treated by shiunko (SK) enema with promising outcomes. The patient underwent interstitial brachytherapy for anterior vaginal vault recurrence of uterine cancer. Nine months after the treatment, she had anal pain and was diagnosed with RP by clinical course and colonoscopy. The rectal ulcer was so severe that a surgeon proposed permanent stoma formation as one option, given eventual risk of rectovaginal fistula. The patient rejected stoma formation and opted for Kampo medicine. Though she took keishibukuryogankayokuinin for blood stasis at first, her anal pain and rectal bleeding gradually worsened. Thereafter, she mainly used SK enema, kyukikyogaito and magnesium oxide. Anal pain and rectal bleeding decreased after applying SK to the rectal wall per rectum. Magnetic resonance imaging (MRI) and colonoscopy findings of the rectal ulcer also improved. SK effectively reduced anal pain and rectal bleeding as well as stimulated tissue repair in our patient, and therefore SK is worth considering in the treatment of RP.

Rectal Ulcer Developed in Systemic Lupus Erythematosus without Ischemic Colitis / 대한소화기학회지

Rectal involvement by systemic lupus erythematosus (SLE) is quite rare. Approximately 14 cases have been reported worldwide, but only one with ischemic colitis has been reported in Korea. A 17-year-old female patient was hospitalized with abdominal pain and hematochezia. Sigmoidoscopy revealed only a simple rectal ulcer without ischemic colitis. cytomegalovirus and bacterial infections were excluded. A sigmoidoscopic rectal biopsy indicated a rectal invasion by SLE, but the patient showed an acute worsening conditions that did not respond to treatment. This paper reports a case of rectal ulcer that developed in SLE without ischemic colitis with a review of the relevant literature.

Rectal Ulcer Developed in Systemic Lupus Erythematosus without Ischemic Colitis / 대한소화기학회지

Rectal involvement by systemic lupus erythematosus (SLE) is quite rare. Approximately 14 cases have been reported worldwide, but only one with ischemic colitis has been reported in Korea. A 17-year-old female patient was hospitalized with abdominal pain and hematochezia. Sigmoidoscopy revealed only a simple rectal ulcer without ischemic colitis. cytomegalovirus and bacterial infections were excluded. A sigmoidoscopic rectal biopsy indicated a rectal invasion by SLE, but the patient showed an acute worsening conditions that did not respond to treatment. This paper reports a case of rectal ulcer that developed in SLE without ischemic colitis with a review of the relevant literature.

Inflammatory cloacogenic polyp: a rare kind of benign polyp to be cured with endoscopic and/or surgical removal / Pólipo cloacogênico inflamatório: um raro tipo de pólipo benigno a ser curado por remoção endoscópica e/ou cirúrgica

Abstract Background Inflammatory cloacogenic polyp is a very rare kind of benign polyp which occurs in the anal transitional zone and lower rectum. These polyps arise in association with various conditions (e.g., internal hemorrhoids, diverticulosis, colorectal tumors, and Crohn's disease) in which mucosal injury is the underlying pathogenic mechanism. Case report A 24-year-old male patient applied to emergency department with bloody defecation for a month. A polyp that is 1.5 cm in size had been observed at rectum and anal verge junction during colonoscopy, pathological diagnosis was inflammatory cloacogenic polyp. Thereupon, colonoscopic polypectomy was performed as the malignant transformation possibility. Conclusion Polyps of the anorectal junction with inflammatory appearance might be inflammatory cloacogenic polyps with malignant transformation potential that must be treated by endoscopic removal or surgery and followed up routinely with colonoscopic surveillance.

Resumo Experiência Pólipos cloacogênicos inflamatórios constituem um tipo muito raro de pólipo benigno, com ocorrência na zona de transição anal e reto baixo. Esses pólipos surgem em associação com diversos distúrbios (p. ex., hemorroidas internas, diverticulose, tumores colorretais, e doença de Crohn) nos quais a lesão à mucosa é o mecanismo patogênico subjacente. Relato de caso Paciente, gênero masculino, 24 anos, compareceu ao serviço de emergência com defecação sanguinolenta com duração de um mês. Durante a colonoscopia, foi observado um pólipo medindo 1,5 cm de diâmetro no reto e na junção da borda anal; foi estabelecido um diagnóstico patológico de pólipo cloacogênico inflamatório. Subsequentemente, foi realizada polipectomia colonoscópica, diante do potencial de transformação maligna. Conclusão Pólipos da junção anorretal com aspecto inflamatório podem ser pólipos cloacogênicos inflamatórios com potencial para transformação maligna, devendo ser tratados por remoção endoscópica ou cirúrgica e monitorados periodicamente com vigilância colonoscópica.

A Case of Solitary Rectal Ulcer Syndrome in a 16-year-old Girl Presented with Iron Deficiency Anemia / 임상소아혈액종양

Solitary rectal ulcer syndrome (SRUS) is a rare condition that is most commonly characterized by rectal pain and bleeding. It can be accompanied by diarrhea or constipation, tenesmus, and rectal prolapse. Considering its non-specific symptoms, it is often difficult to diagnose, particularly in children. The underlying etiology of SRUS is not fully understood; however, it may be secondary to ischemic changes in the rectum associated with paradoxical contraction of the pelvic floor and external anal sphincter muscles and rectal prolapse. The macroscopic appearance of the rectal lesion may vary from hyperemia to ulceration or a polypoid lesion that can mimic carcinoma, although the histological findings are characteristic, with fibromuscular obliteration of the lamina propria and disorientation of muscle fibers. We report an adolescent case of SRUS developed in a 16-year-old adolescent girl who presented with iron deficiency anemia.

A Case of Solitary Rectal Ulcer Syndrome in a 16-year-old Girl Presented with Iron Deficiency Anemia / 임상소아혈액종양

Solitary rectal ulcer syndrome (SRUS) is a rare condition that is most commonly characterized by rectal pain and bleeding. It can be accompanied by diarrhea or constipation, tenesmus, and rectal prolapse. Considering its non-specific symptoms, it is often difficult to diagnose, particularly in children. The underlying etiology of SRUS is not fully understood; however, it may be secondary to ischemic changes in the rectum associated with paradoxical contraction of the pelvic floor and external anal sphincter muscles and rectal prolapse. The macroscopic appearance of the rectal lesion may vary from hyperemia to ulceration or a polypoid lesion that can mimic carcinoma, although the histological findings are characteristic, with fibromuscular obliteration of the lamina propria and disorientation of muscle fibers. We report an adolescent case of SRUS developed in a 16-year-old adolescent girl who presented with iron deficiency anemia.

An Unusual Case of Proctitis and Rectal Abscess due to Irritants by Artemisia asiatica Smoke (Ssukjwahun) / 대한소화기학회지

Proctitis is an inflammatory change of rectal mucosa induced by various agents or stimulus. Among many etiologies, it may be caused by medical treatments such as radiation or antibiotics. Proctitis usually presents with rectal ulcer but abscess formation is uncommon. Therapy using Ssukjwahun exerts its effect by directly applying the smoke around genital area and anus with various medicinal brewed herbs, especially worm-wood. Secondary metabolite of this plant, monoterpene, is known to facilitate circulation, exert anti-inflammatory effect, and help control pain. Herein, we report an unusual case of infectious proctitis presenting with rectal ulcer and abscess formation after perianal application of warm steam made by Artemisia asiatica smoke for treatment of dysmenorrhea.

Síndrome de úlcera rectal solitaria en niños: Reporte de 3 casos

El síndrome de la úlcera rectal solitaria es una entidad benigna poco común cuyos síntomas más frecuentes son la rectorragia y el dolor anal. Los hallazgos anatomopatológicos son típicos. Se suele evidenciar engrosamiento de la mucosa, elongación y distorsión de las glándulas, una lámina propia edematosa con gran cantidad de colágena y engrosamiento de la muscularis mucosae. El diagnóstico se realiza mediante endoscopia con toma de biopsias. Se suele localizar preferentemente en la cara rectal anterior y/o lateral, aunque hasta un 30% de las lesiones son múltiples, existiendo casos de afectación del colon sigmoide y descendente. El Síndrome de úlcera rectal solitaria es muy raro en niños y la mayoría de revisiones en este grupo se limitan a descripción de casos. Se presentan tres casos con las características de este síndrome y lo infrecuente de su presentación en edades pediátricas.

Solitary rectal ulcer syndrome is an uncommon benign condition characterized by rectal bleeding, passage of mucus, and pain. Histological features are well established as obliteration of the lamina propia by fibrosis and smooth-muscle fibers extending from a thickened muscularis mucosa to the lumen. Diagnosis can usually be made on sigmoidoscopy, and biopsies should always be taken. Ulceration is not universally present, and polypoid, non-ulcerated lesions and erythematous areas are also seen. The lesion or lesions are most often found on the anterior or anterolateral wall of the rectum, although they can also be located in the left colon and be more extensive or even circumferential. Lesions are multiple in 30 percent of cases. The solitary rectal ulcer syndrome is very rare in children and most of revisions in this group are limited to case description. Three cases with the characteristics of this rare syndrome and its presentation in pediatric patients are presented.

Coexistence of Solitary Rectal Ulcer Syndrome and Ulcerative Colitis: A Case Report and Literature Review

Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease that is misdiagnosed as malignancy or inflammatory bowel disease because of similarities in clinical and endoscopic manifestations. Furthermore, SRUS with ulcerative colitis (UC) is extremely rare. To date, two cases have been reported in the medical literature. We report an additional case of SRUS with UC that was misdiagnosed as rectal cancer. A 61-year-old man was admitted to our hospital with rectal bleeding. Colonoscopy showed a well-demarcated, shallow, ulcerative lesion with polypoidal growth involving the entire circumference of the rectal lumen. Findings from imaging studies, including abdominal computed tomography (CT) and positron emission tomography (PET)/CT resembled those of rectal cancer. Surgical resection was performed because clinical symptoms persisted despite medical treatment and because occult rectal cancer could not be ruled out. Histopathological examination of the resected specimen revealed fibromuscular obliteration of the lamina propria and crypt abscesses, characteristics compatible with SRUS and UC.

Solitary Rectal Ulcer Syndrome in Children: A Report of Six Cases

Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. The underlying etiology is not well understood, but it is secondary to ischemic changes and trauma in the rectum associated with paradoxical contraction of the pelvic floor and the external anal sphincter muscles; rectal prolapse has also been implicated in the pathogenesis. This syndrome is diagnosed based on clinical symptoms and endoscopic and histological findings, but SRUS often goes unrecognized or is easily confused with other diseases such as inflammatory bowel disease, amoebiasis, malignancy, and other causes of rectal bleeding such as a juvenile polyps. SRUS should be suspected in patients experiencing rectal discharge of blood and mucus in addition to previous disorders of evacuation. We herein report six pediatric cases with SRUS.

Solitary Rectal Ulcer Syndrome in Patients with Spinal Cord Injury: 28 Cases Report / 中国康复理论与实践

@#Objective To explore the diagnosis, treatment and pathogenesis of solitary rectal ulcer syndrome (SRUS) in patients with spinal cord injury (SCI). Methods 260 patients with SCI accepted rectal diseases survey, anal examination and anus straight endoscopic. Those who had rectal ulcer also performed biopsy, and patients who had been diagnosed as SRUS were evaluated by the index of International bowel function basic SCI data set, then further accepted non-operative or surgical treatment, and regular reexamination with anal straight colonoscopy for clinical evaluation after discharge. Results and Conclusion Bowel dysfunction, constipation, and anal rectum prolapsed, improper uses of glycerine enema were important causes of SRUS after SCI. Non-operative therapy as well as strengthening defecate management could be an effective treatment for SRUS after SCI.

Solitary Rectal Ulcer Syndrome: A Case Series.

A retrospective analysis of the clinical profile, endoscopic features and management of 22 children (age 18 months – 18 years) diagnosed as solitary rectal ulcer syndrome is presented. The majority (81.8%) were ≥8 years of age. Rectal bleeding was the presenting feature in all the children. Mucorrhea, constipation, tenesmus and rectal prolapse were observed in 77.3%, 63.6%, 59% and 13.6% children, respectively. Colonoscopy showed classical single rectal ulcer in 68.2% and multiple ulcers in 22.7%. Polypoidal and erosive lesions were documented in 4.5% each. The medical management comprised of bowel training and high fibre diet for all children. The other modalities included oral 5-amino salicylate (59%), sucralfate enema (4.5%) and rectal mesalamine in 9%. 64% children recovered and 13.6 % had recurrence of symptoms.

Acute hemorrhagic rectal ulcer in a patient with lung cancer

<b>Purpose</b>: Acute hemorrhagic rectal ulcer (AHRU) commonly occurs in elderly who are bedridden for long time due to severe underlying diseases such as cerebral and myocardial infarction and their complications. However, it is uncommon in end-stage cancer patients receiving palliative care. We report a rare AHRU case in his forties who had lung cancer with paraplegia due to tumor invasion. <b>Case</b>: A male lung cancer patientwas admitted to our hospital for new-onset paraplegia caused by spinal cord invasion. On 25th day after admission, he suffered from a little rectal bleeding. From that day, a painless rectal bleeding becomes gradually increased. On 37th day, a massive bleeding was occurred. Endoscopy showed that there was no active bleeding but an exposed vessel and partial circumferential ulcer in the lower part of rectum, which was compatible with the finding of AHRU. The lesion was successfully treated by clipping and no re-bleeding was observed after clipping. He was discharge on 103rd day. <b>Conclusion</b>: AHRU should be considered in the differential diagnosis of a massive melena in end-stage cancer patients. Prompt diagnosis and therapy is important because this disease is curable even in the terminal stage to improve their quality of life. Palliat Care Res 2011; 6(1): 308-312

Improper Use of Glycerol Enema and Rectal Ulcer(review) / 中国康复理论与实践

@#Glycerol enema, mainly composed of glycerol, sorbitol, and magnesium sulfate, was a kind of OCT caccagogue. The application of convenience, low prices made it used widely in patients with constipation. However, if the drug should not follow the indications and application of Methods , a series of improper consequences will be caused. The authors reviewed the application of Glycerol Enema, rectal injury and rectal ulcer in patients with constipation.

Clinical and Endoscopic Characteristics of Acute Hemorrhagic Rectal Ulcer and the Risk Factor of Rebleeding

BACKGROUND/AIMS: Acute hemorrhagic rectal ulcers (AHRUs) are rare and have not been thoroughly studied. This study aimed to assess the clinical and endoscopic characteristics of AHRUs and to determine the risk factors for rebleeding after the initial management. METHODS: Thirty patients who underwent colonoscopy within 48 hours of the onset of hematochezia were consecutively enrolled between January 2004 and December 2007. The patients were divided into a rebleeding group and a non-rebleeding group according to presence of recurrent bleeding after initial management. We analyzed the clinical features, including the underlying disorder, the Karnofsky performance status (PS), the use of anticoagulant or antiplatelet agents, the endoscopic findings, and the methods used for hemostasis. RESULTS: All of the patients were elderly, in a bedridden status, and all had experienced the sudden onset of massive, fresh rectal bleeding without pain. The characteristics of the lesions on colonoscopy included solitary or multiple rectal ulcers, or Dieulafoy lesions located in the distal rectum. There were no differences between the two groups based on mean age, gender, use of anticoagulant or antiplatelet agents, PS, methods of hemostasis, and clinical outcomes. The PT (INR) and endoscopic findings (Dieulafoy types), however, differed significantly between the two groups (p=0.024 and p=0.013, respectively). CONCLUSIONS: When massive hematochezia occurs in bedridden patients with severe comorbid illnesses, AHRUs should be considered in the differential diagnosis. It is advisable to be vigilant for rebleeding in patients with prolongation of the PT (INR) and Dieulafoy-type ulcers on colonoscopy.

A Case of a Polypoid Solitary Rectal Ulcer Syndromewith Rectal Prolapse / 대한소아소화기영양학회지

Solitary rectal ulcer syndrome (SRUS) is a rare disorder in children. There are few investigations about the exact incidence and effective treatment of SRUS in children. We describe a 12-year-old male patient who had rectal prolapse for 9 years, hematochezia for 7 months, and was diagnosed with polypoid solitary rectal ulcer syndrome with rectal prolapse by colonoscopy. Anorectal manometry was also performed to evaluate the cause of frequent relapses.

A case of acute hemorrhagic rectal ulcer syndrome / 대한내과학회지

Acute hemorrhagic rectal ulcer syndrome (AHRUS) is characterized by the sudden onset of painless, massive, fresh rectal bleeding in elderly or bedridden patients with serious underlying illnesses. With increasing elderly populations, and improved survival in critically ill patients, the incidence of AHRUS has increased in Japanand Western countries in recent years. However, AHRUS remains a controversial disease entity and has not yet been documented in Korea. Here, we present a case of AHRUS to highlight this uncommon disease entity as a potential etiology of massive rectal bleeding in critically ill patients.

Solitary Rectal Ulcer Syndrome with Lesion of Polypoid Growth

Solitary rectal ulcer syndrome (SRUS) is a rare disorder characterized by rectal ulceration associated with typical histological features and disturbed defecatory behaviour from the passage of blood and mucus. While the cause of SRUS is yet unknown, the rectal prolapse and the paradoxical contraction of pelvic floor muscles have been considered the most important factors. The diagnosis is made usually on the basis of clinical symptoms, endoscopic appearance, and histology. Despite the terminology of SRUS, patients often show multiple lesions instead of just a single lesion or polypoid lesions instead of ulcerative lesions. Polypoid lesions, especially when combined with histologic findings of colitis cystica profunda, may sometimes be mis-interpreted as cancer. We report the case of one female patient with SRUS with out-growing polypoid lesion, which was misdiagnosed as invasive cancer on endoscopic biopsy.

A Case of Solitary Rectal Ulcer Syndrome / 소아과

Solitary rectal ulcer syndrome(SRUS) is a rare disorder in children. The incidence of SRUS is highest in young adults, and sex distribution is equal, or there may be a slight female predominance. There are few investigations about the exact incidences and effective treatment protocols of SRUS in children. The clinical symptoms and signs of SRUS are accompanied by rectal bleeding, mucous discharge, prolonged straining, tenesmus, and localized perineal pain. The time intervals between the onset of symptoms and the establishment of accurate diagnosis varied between five and seven years. It was the reason why most patients showed nonspecific symptoms and laboratory test results. We have described a 12-year-old female patient, who suffered intractable lower abdominal pain for three years, and was diagnosed as a solitary rectal ulcer syndrome by rectosigmoidoscopy.

A Case of Solitary Rectal Ulcer Syndrome with Characteristic Findings of Evacuation and Magnetic Resonance (MR) Defecography / 대한소화관운동학회지

Solitary rectal ulcer syndrome is an uncommon, chronic benign condition characterized by rectal bleeding, the passage of mucus, tenesmus and excessive straining during defecation. Occasionally, solitary rectal ulcer syndrome has been reported to be associated with defecation disorder such as pelvic floor dyssynergia, rectal intussusception and rectal prolapse. However, it is ambiguous how these associated defecation disorders contribute to make the rectal ulcer. We report a case of solitary rectal ulcer syndrome suggesting the pathophysiology of rectal ulcer by typical findings of evacuation defecography and MR defecography. A 40-year-old man presented with lower abdominal pain, rectal bleeding, passage of mucus and tenesmus intermittently for the past 4 years. Colonoscopy showed a large geographic and circumferential ulcer at the 10 cm distance from the anal verge. A biopsy revealed fibromuscular proliferation of laminar propria, hyperplasia of crypt and focal superficial ulceration. Finally, he was diagnosed as solitary rectal ulcer syndrome. Evacuation defecography showed paradoxical movement of puborectal sling and unusual invagination of rectal walls during defecation. In addition, rectum showed spastic movement and anterior rectal wall directly merged into posterior rectal wall making a kissing appearance. The invagination of the rectum at evacuation defecography proved to be the rectal wall thickening at MR defecography. After 9 sessions of biofeedback therapy, his defecation symptoms improved. However, ulcer was still observed without interval change.