American Journal of Biological and Pharmaceutical Research

EFFECTS OF NON-SURGICAL TREATMENT OF 42 CASES WITH SOLITARY RECTAL ULCER- A RETROSPECTIVE STUDY FROM A SINGLE CENTRE OF EASTERN INDIA

Biswarup Bose1, Amit Kumar Samanta2, Kakali Roy Basu3, Abhimanyu Basu4*

ovmanyubasu@yahoo.co.in

Solitary, Rectal, Ulcer, Bleeding, Behavioral therapy, Sucralfate.

Solitary rectal ulcer is a rare disorder characterized by erythema or ulceration of the rectal wall, associated with typical histological features, and disturbed defecatory behavior with the passage of blood and mucus. The treatment is difficult and the patients often frustrated. For further characterization, retrospective, a hospital-based review of diagnosed SRU and then the effect of treatment were conducted. 42 cases were diagnosed at Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata between 2000 and 2011 were reviewed and evaluated. Review of literature search (Medline) and manual cross-referencing were also done. 42 cases were identified: 28 males and 14 females. The age range was 17-70 years. Blood and mucus discharge, constipation / tenesmus and pain were the most common presenting symptoms and were seen, either alone or in various combinations. The pathogenesis is likely to vary in different patients: it include trauma from straining, direct digital trauma, and possibly primary neuromuscular pathology. The histopathological findings of extension of the muscularis mucosa between crypts and muscularis propria disorganization on full thickness specimens are characteristic. Behavioral therapy, including habit training, can lead to symptom improvement and return to work in majority of patients. Application of Topical Sucralfate long term symptom improvement in 70% 0f our patients. Rectal ulceration may persist after any treatment, even if the symptomatology improved. SRU is a rare disorder and only 42 cases were diagnosed at our Institution at Kolkata which mainly serves the population of Eastern India. The clinical pattern of our patients was variable and often mimics clinical presentation of rectal cancer patients. Behavioral therapy, topical Sucralfate and carefully considered surgical interventions offer the best treatment results. Further work on psychological factors and neuromuscular and vascular pathology is required.