Solitary rectal ulcer syndrome: radiologic manifestations

The solitary rectal ulcer syndrome is a distinct clinical entity occurring mainly in young patients who experience rectal bleeding. Solitary, and occasionally multiple, ulcers occur predominantly on the anterior or anterolateral aspects of the rectum. Current theories attribute this to pelvic muscle discoordination during defecation with partial rectal mucosal prolapse and traumatic ulceration. Classical histologic changes have been demonstrated that enable accurate diagnosis by the pathologist. Ten cases of biopsy-proven solitary rectal ulcer syndrome were reviewed. The radiographic abnormalities were: nodularity of the rectal mucosa (three cases), stricture formation (two cases), polypoid rectal masses (two cases), and ulceration (two cases). Radiologically this condition must be differentiated from other more serious entities such as carcinoma or inflammatory bowel disease.