TRAUMATIC SOLITARY RECTAL ULCER IN SAUDI-ARABIA - A DISTINCT ENTITY

Solitary rectal ulcer syndrome is a perplexing condition with a comple x multifactorial pathophysiology. Inappropriate contraction of the pub orectalis muscle and rectal mucosal prolapse have been commonly implic ated, although self-induced trauma has been suspected in some cases. E ight patients who presented with rectal bleeding with excessive mucus were found to have an isolated rectal ulcer on proctosigmoidoscopy. Co nstipation, straining at stools, and pain in the anal region were pres ent in seven of eight cases. All of them confessed to rectal digitatio n. Most of them had consulted more than two physicians and half of the m had had barium enema and colonoscopy in the past. An ulcer was prese nt on the anterior wall at 6-8 cm from the anal verge in seven of eigh t patients and none of them had either external or internal rectal pro lapse. Rectal biopsy performed in six of eight showed histological fin dings consistent with the diagnosis of solitary rectal ulcer. Patients were convinced to stop finger evacuation and were given psyllium supp lements. There was endoscopic healing with symptomatic improvement in the six patients who followed up for an average period of 38 weeks. We conclude that traumatic solitary rectal ulcer due to rectal digitatio n is a distinct entity and response to avoidance of this habit is good .