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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rectal prolapse and solitary rectal ulcer syndrome are both benign conditions affecting the rectum, mainly in women; prolapse tends to occur late in life, while solitary rectal ulcer syndrome has a predilection for the younger adult. Complete rectal prolapse probably starts as a mid-rectal intussusception, although a combination of this theory and the 'sliding hernia' theory has been proposed by Altemeier et al (1971). The pelvic floor weakness associated with prolapse, which gives rise to incontinence, is most likely due to a traction injury to the pudendal nerve. Anorectal manometry will indicate those incontinent patients likely to benefit from rectopexy. Abnormal descent of the perineum may be found in rectal prolapse and solitary rectal ulcer syndrome as well as descending perineum syndrome per se. The clinical features of these three conditions can overlap. Solitary rectal ulcer syndrome is essentially due to prolapse and traumatization of the rectal mucosa. Inappropriate puborectalis contraction, abnormal perineal descent, and overt rectal prolapse have all been cited as possible mechanisms of development of the condition. Defecography is the radiologic investigation of choice. Electromyography, as in rectal prolapse, may show evidence of pudendal nerve damage although incontinence is rare.
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PMID:The pathogenesis and pathophysiology of rectal prolapse and solitary rectal ulcer syndrome. 353 17

Reports of solitary rectal ulcer syndrome (SRUS) from the United States are rare. A retrospective analysis of biopsy specimens over a period of 5 years yielded 12 patients who fulfilled the histopathologic criteria for this disorder. The clinicopathologic features of patients in this series are similar to those previously reported; the majority presented with solitary ulcerated or polypoid lesions located 4-18 cm from the anal margin. The initial clinical diagnosis was never SRUS; carcinoma and inflammatory bowel disease were considered most likely in one and three cases, respectively. Three patients had mucosal prolapse. Solitary rectal ulcer syndrome was the initial pathologic diagnosis in only four patients (33%). We conclude that SRUS is frequently underdiagnosed both clinically and pathologically in this country. The pathologist might be the first to suggest this diagnosis to the clinician by recognizing its characteristic histopathologic features.
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PMID:Solitary rectal ulcer syndrome. Its clinical and pathological underdiagnosis. 409 Nov 79

We studied the physiological features of patients with complete rectal prolapse and different degrees of solitary rectal ulcer syndrome to determine whether these conditions are likely to form part of the same disorder. 52 solitary rectal ulcer patients (median age 31, 40 females), and 15 complete rectal prolapse patients (median age 31, 12 females) were studied. Solitary rectal ulcer patients were divided into 3 groups, based on the extent of accompanying rectal prolapse (no prolapse, internal prolapse, or external prolapse). Both solitary rectal ulcer patients without prolapse and with internal prolapse had significantly higher maximum anal resting (p < 0.01 for both groups) and squeeze pressure (p < 0.05 for both groups) than complete rectal prolapse patients. In contrast, solitary rectal ulcer patients having external prolapse were similar to those with complete rectal prolapse. Solitary rectal ulcer patients without rectal prolapse had significantly decreased anal and rectal electrosensitivity (p < 0.01 for both) when compared to healthy control subjects. Solitary rectal ulcer patients therefore have a spectrum of clinical and physiological features--this condition may comprise a range of different disease entities. The findings also suggest a different underlying aetiopathophysiology of solitary rectal ulcer from that of complete rectal prolapse.
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PMID:Solitary rectal ulcer and complete rectal prolapse: one condition or two? 763 79

Solitary rectal ulcer syndrome is a perplexing condition with a complex multifactorial pathophysiology. Inappropriate contraction of the puborectalis muscle and rectal mucosal prolapse have been commonly implicated, although self-induced trauma has been suspected in some cases. Eight patients who presented with rectal bleeding with excessive mucus were found to have an isolated rectal ulcer on proctosigmoidoscopy. Constipation, straining at stools, and pain in the anal region were present in seven of eight cases. All of them confessed to rectal digitation. Most of them had consulted more than two physicians and half of them had had barium enema and colonoscopy in the past. An ulcer was present on the anterior wall at 6-8 cm from the anal verge in seven of eight patients and none of them had either external or internal rectal prolapse. Rectal biopsy performed in six of eight showed histological findings consistent with the diagnosis of solitary rectal ulcer. Patients were convinced to stop finger evacuation and were given psyllium supplements. 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 digitation is a distinct entity and response to avoidance of this habit is good.
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PMID:Traumatic solitary rectal ulcer in Saudi Arabia. A distinct entity? 858 4

Solitary rectal ulcer, internal rectal intussusception, and complete rectal prolapse are a range of defaecatory disorders that may have a common aetiology, namely chronic straining. If the pelvic floor is weak, external prolapse is often complicated by faecal incontinence. Few patients, a lack of randomised trials, and difficulties in the interpretation of studies of anorectal physiology (the results of which often seem conflicting) have made the understanding of these disorders difficult. The basis for treatment is clear, however--patients who have symptomatic defaecatory disorders associated with an internal intussusception, or solitary rectal ulcer, or both should have a course of training of pelvic floor muscles, dietary advice, and should use fibre supplements as primary treatment. Operation should be reserved for those patients in whom medical treatment has failed, and it may be expected to relieve symptoms in above two thirds of patients. Defaecating proctography may be useful in assessing which patients may not benefit from operation. Operation is the primary treatment for external prolapse. The choice of surgical approach should be tailored according to the expertise available, the medical condition of the patient, and the presence or absence of pre-existing constipation or incontinence.
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PMID:Rectal prolapse and rectal invagination. 966 65

Solitary rectal ulcer syndrome (SRUS) is an infrequent pathology often associated with pelvic floor disorders. The aim of this retrospective study was to review the long-term results of a surgical series of SRUS. Between 1988 and 1998, 13 patients were operated on for SRUS. Seven patients had associated internal rectal prolapse (58%), two had associated total rectal prolapse (15%), and two had associated mucosal prolapse (15%). We performed simple resection of the SRUS in one case (8%), a stoma as primary operation in one (8%), three rectopexies according to Orr-Loygue (23%), and eight Delorme's operations as modified by Berman (62%). Mean follow-up was 57 months (range 15-112). Simple resection of the solitary rectal ulcer syndrome did not improve symptoms. Colostomy permitted relief of symptoms and healing of the SRUS. Two of the three rectopexies achieved good results, and the third patient relapsed at the 6th postoperative month. A secondary modified Delorme's operation permitted relief of symptoms and healing of the SRUS. Five of the eight patients (62.5%) who received modified Delorme's operations had improved at a follow-up of 46 months. We conclude that, considering the high failure rate after surgery, operations should be performed only in patients with total rectal prolapse or intractable symptoms not amenable to behavioral therapy. Delorme's operation and abdominal rectopexy help in about 60% of cases.
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PMID:Solitary rectal ulcer syndrome: a series of 13 patients operated with a mean follow-up of 4.5 years. 1151 82

Solitary rectal ulcer syndrome (SRUS) is a rare condition in children. We report a case of SRUS in an 8-year old Saudi girl who presented with recurrent rectal bleeding, intermittent mucosal prolapse, and passage of mucus per rectum. Colonoscopy revealed multiple polypoid mass lesions with histopathological features of SRUS. The polypoid variant of SRUS is very rare in children and may be confused with rectal malignant or inflammatory conditions.
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PMID:Solitary rectal ulcer syndrome presenting as polypoid mass lesions in a young girl. 2116 Aug 95

Solitary rectal ulcer syndrome is a rare clinical entity. Several treatment options has been described. However, there is no consensus yet on treatment algorithm and standard surgical procedure. Rectopexy is one of the surgical options and it is generally performed in patients with solitary rectal ulcer accompanied with overt prolapse. Various outcomes have been reported for rectopexy in the patients with occult prolapse or rectal intussusception. In the literature; outcomes of laparoscopic non-resection rectopexy procedure have been reported in the limited number of case or case series. No study has emphasized the outcomes of laparoscopic non-resection rectopexy procedure in the patients with solitary rectal ulcer without overt prolapse. In this report we aimed to present clinical outcomes of laparoscopic non-resection posterior suture rectopexy procedure in a 21-year-old female patient with solitary rectal ulcer without overt prolapse.
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PMID:Laparoscopic rectopexy for solitary rectal ulcer syndrome without overt rectal prolapse. A case report and review of the literature. 2479 25

Solitary rectal ulcer syndrome (SRUS) is a chronic, multiform, non-cancerous disorder of the rectum, the final diagnosis of which is based upon histopathological criteria. This disorder is often accompanied by latent proctoptosis. We present a patient who (in 1996) was the first case in which argon plasma coagulation (APC) was used for SRUS treatment. In the years 2004-2005 the same patient underwent 15 APC sessions (at monthly intervals) obtaining full recovery from SRUS, although she had been treated unsuccessfully for 17 years prior to that. Six-year observation did not show any relapse. Local therapy with APC seems to be an important alternative in SRUS treatment without prolapse of the rectum and could become a basic method for bleeding treatment in SRUS.
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PMID:Effective treatment of solitary rectal ulcer syndrome using argon plasma coagulation. 2527 57