Managing solitary rectal ulcer syndrome: ignore the ulcer, treat the underlying advanced rectalprolapse: P013

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Aim:Solitary rectal ulcer syndrome (SRUS) is an unusual benign syndrome associated with obstructed defaecation (OD) whose pathophysiology and management remain controversial. We aimed to evaluate clinical features and surgical outcomes in patients with SRUS.Method:Data on patients with histologically-proven SRUS from aprospective pelvic floor database were analysed. Parameters assessed were: demographics, clinicalpresentation, defaecography, underlying diagnosis, treatment and outcomes.Results:Twenty-three patients with SRUS and OD were identified (83% female, age median 48, range 15-81 years, diagnosis 1-19 yearsprior). In 22 patients (96%) the underlying diagnosis was either high-grade internal (16) or external rectalprolapse (ERP) (6). Surgery undertaken (15) was laparoscopic ventral rectopexy (14) and STARR (1). One patient with severe established rectal stricture failed STARR, ventral rectopexy and underwent loop ileostomy. Three patients required completion posterior STARR following ventral rectopexy. 13/15 patients (87%) were improved by surgery with significant improvements in OD (P = 0.04) and faecal incontinence (FI) (P = 0.03) at 3 months. Two patients developed symptomatic strictures at the site of the healed SRU, treated by per-anal stricture release.Conclusion:SRUS is an unusual manifestation of advanced rectalprolapse. The ulcer should generally be ignored and the underlyingprolapse treated by nerve-sparing ventral rectopexy before severe rectal stricture is established.

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