Solitary Rectal Ulcer Syndrome with Fibrotic Rectal Stricture: A Diagnostic Dilemma

Solitary rectal ulcer syndrome (SRUS) is an uncommon, benign condition that presents with a wide range of symptoms mimicking other pathological conditions, often leading to misdiagnosis and delays in treatment. A 60-year-old male patient was diagnosed with SRUS with rectal stricture with the help of colonoscopy, anorectal manometry, magnetic resonance defecography, and histopathological examination. He was managed with high-fiber diet, laxatives, biofeedback therapy, argon plasma coagulation, and stricture dilatation, which effectively alleviated the patient's condition. SRUS is a rare benign condition typically associated with mucosal trauma from chronic straining, self-induced rectal manipulation, or rectal prolapse. The pathogenesis behind SRUS includes rectal wall compression, ischemia due to poor blood supply, chronic inflammation, and mechanical trauma due to repeated digital evacuation, leading to mucosal ulceration and, in some cases, fibrosis and stricture formation. Stricture in SRUS is rare and may mimic malignancy, leading to delays in appropriate diagnosis. The differential diagnosis includes inflammatory bowel disease and neoplasms. Hence, histological confirmation is critical. SRUS with rectal stricture is an unusual presentation that requires a high index of suspicion. Histopathological confirmation remains the gold standard for diagnosis. Early diagnosis is, therefore, essential for effective management of SRUS.