EVACUATION PROCTOGRAPHY IN PATIENTS WITH SOLITARY RECTAL ULCER SYNDROME - ANATOMIC ABNORMALITIES AND FREQUENCY OF IMPAIRED EMPTYING AND PROLAPSE

OBJECTIVE. Solitary rectal ulcer syndrome is characterized by rectal b leeding, tenesmus, and difficult evacuation. Evacuation proctography c an be used in patients with solitary rectal ulcer syndrome to diagnose associated internal or external rectal prolapse and delayed or incomp lete rectal emptying. The objective of this study was to determine the proctographic abnormalities and the frequency of rectal prolapse and incomplete or delayed emptying in a large group of patients with solit ary rectal ulcer syndrome. MATERIALS AND METHODS. Proctographic examin ations of 53 patients with histologically proved solitary rectal ulcer syndrome were reviewed retrospectively. Evacuation proctography was d one by a standard technique. The rate and completeness of rectal empty ing and structural abnormality of the rectum were recorded. Comparison was made with a control group of 20 subjects who had no anorectal sym ptoms. RESULTS. Fourteen patients (26%) with solitary rectal ulcer syn drome had rectal irregularity at rest compared with none in the contro l group. Rectal prolapse developed on evacuation in 36 patients (68%) with solitary rectal ulcer syndrome: internal prolapse in 24 patients (45%), and external prolapse in 12 (23%). Descent of the pelvic floor on evacuation was greater in the solitary rectal ulcer syndrome group (median, 4.4 cm; range, 0-10.0 cm) than in the control group (median, 3.3 cm; range, 0.6-5.3 cm; p = .006). Thickened rectal folds were seen in 11 (55%) of 20 patients with solitary rectal ulcer syndrome examin ed with posteroanterior proctography. Evacuation was prolonged and inc omplete in patients with solitary rectal ulcer syndrome (median, 15 se c; range, 3-60 sec) compared with control subjects (median, 10 sec; ra nge, 3-30 sec; p = .012). All control subjects evacuated more than two thirds of the contrast material in less than 30 sec compared with onl y 41 patients with solitary rectal ulcer syndrome (77%). Overall, evac uation proctography disclosed delayed or incomplete emptying and/or re ctal prolapse in 40 patients (75%) with solitary rectal ulcer syndrome compared with two control subjects who showed low-grade internal rect al prolapse only (p < .0001). CONCLUSION. Solitary rectal ulcer syndro me is significantly associated with prolonged and incomplete evacuatio n and with an increased prevalence of internal and external rectal pro lapse.