[Treatment of isolated rectal ulcer syndrome]

Our study involved a group of 46 cases of isolated rectal ulcer syndrome. We believed that our management procedure would have to take several factors into consideration. Firstly, the clinical context is of primary importance: the age, psychological context, functional signs and, above all, the state of the lesions. We attached particular importance to distinguishing between the forms of proctitis (whether ulcerated or not) and the pseudotumoral polypoid forms. In addition, complementary explorations (dynamic rectography and anorectal manometry) can provide valuable information (the degree of prolapse, impairment of the exoneration mechanism and the status of sphincter function). In both ulcerated and non-ulcerated forms of proctitis, the treatment is essentially medical and intended to treat the constipation and rehabilitate the exoneration. This treatment suffices in most cases. In poorly tolerated cases, involving persistent bleeding or in forms corresponding to major prolapse, surgery is required which usually includes proctopexy. The first problem posed by pseudotumoral polypoid forms is that of a differential diagnosis to formally exclude cancer or an inflammatory disease process. Transanal biopsy exeresis may be crucial in the diagnosis. In addition, this transanal resection may well initiate therapy, in combination with medication. In some forms, involving major prolapse, it is logical to combine rectopexy. In some cases, rectopexy may be necessary if simple transanal resection is unsuccessful (persistence or recurrence of lesions). Rectopexy is also frequently the only treatment possible of pseudotumoral forms affecting extensive areas or higher regions of the bowel.