Solitary rectal ulcer syndrome. A Tunisian monocentric Survey

Solitary rectal ulcer syndrome is an uncommon and benign defecation disorder. Occidental series are scarce and to our knowledge, Tunisian data are not available. The aim of this study was to evaluate the clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome. All the patients diagnosed with solitary rectal ulcer syndrome from January 2001 to 2012 were included in the study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic, histological and therapeutic findings. A total of 15 patients were evaluated: 7 males; mean age 42.6 years. Bleeding per rectum was present in 66% and dyschezia in 73%. Endoscopically, solitary lesion was present in 66% patients. The most frequent dynamic abnormalities shown by defecography were of rectal intussusception (53%). Anorectal manometry was performed in seven cases disclosing dyssynergia in 2 cases. Thirty patients underwent surgery, always after failure of medical treatment and one patient was treated with biofeedback. Rectopexy was the most utilized technic. After a mean follow-up of 29 months, total regression of symptoms was noted in 50% of patients who underwent surgery. In this cohort, diagnostic and therapeutic spectrum of solitary rectal ulcer syndrome was comparable to occidental features. Nevertheless, accesses to manometry and defecography as well as biofeedback were limited.