Intest Res.  2014 Jan;12(1):70-73. 10.5217/ir.2014.12.1.70.

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

• Park HB
• Park HC
• Chung CY
• Kim JS
• Myung DS
• Cho SB
• Lee WS
• Joo YE

• KMID: 2174341
• DOI: http://doi.org/10.5217/ir.2014.12.1.70

Abstract

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.

Keyword

Solitary rectal ulcer syndrome; Ulcerative colitis; Rectal neoplasms; Surgery

MeSH Terms

Abscess
Colitis, Ulcerative*
Colonoscopy
Hemorrhage
Humans
Inflammatory Bowel Diseases
Middle Aged
Mucous Membrane
Positron-Emission Tomography
Rectal Neoplasms
Ulcer*

Figure

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  Fig. 1 Colonoscopic findings. Colonoscopy shows a well-demarcated, shallow ulcerative lesion with polypoid growth involving the entire circumference of the rectal lumen (A). In addition, loss of vascular pattern and the presence of mucopus coating and edema were noted (B).

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  Fig. 2 Abdominal CT findings. CT reveals concentric wall thickening with enhancement in the rectum (A) and enlargement of the regional lymph nodes (B).

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  Fig. 3 Fluorine-18-fluorodeoxyglucose (FDG)-positron emission tomography/CT findings. PET/CT reveals increased FDG uptake in the rectum and regional lymph nodes.

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  Fig. 4 Histopathological findings of the rectum. Histopathological examination of the resected specimen reveals thickening of the muscularis mucosa and fibromuscular obliteration of the lamina propria (A). Crypt abscesses, focal gland destruction, and increased inflammatory cells in the lamina propria are also seen (B) (H&E stain, ×100).

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