SOLITARY RECTAL ULCER SYNDROME IN CHILDRE N

We report on an 8 year old boy and a 12 year old girl with intermitten t peranal loss of blood and mucus,impaired defecation and recurrent ab dominal pain. On endoscopy isolated ulcers were seen in the rectum onl y, whereas the colonic mucosa appeared to be normal macroscopically an d microscopically. Biopsies from the borders of the ulcers revealed a hyperplasia of the lamina muscularis mucosae and a fibromuscular oblit eration of the lamina propria mucosae. These clinical, endoscopical an d histological findings are characteristic for the solitary rectal ulc er syndrome. Only 26 paediatric cases (age at diagnosis 6-9 years) hav e been published so far. The interval from first symptoms to final dia gnosis (mean: 3,7 years, range: 1 week to 9 years) is remarkably long in childhood cases. Pathogenetically an internal rectal prolapse with secondary ischemic lesions is assumed. There is no evidence of an asso ciation to inflammatory bowel disease. The ulcers ars often resistant to different medical and surgical options. Discussion: Pediatricians s hould be aware of the solitary rectal ulcer syndrome in order to make an earlier diagnosis and to prevent unnecessary diagnostic procedures and concerns of patients and their parents about more severe illnesses .