Wrzód samotny odbytnicy – aktualne postępowanie diagnostyczne i terapeutyczne

*Małgorzata Kołodziejczak¹, Paweł Święcki²

Summary
Solitary rectal ulcer syndrome (ulcus solitarius recti) is a benign condition of rectum with unknown etiology. Direct cause of condition is unknown, however, in opinion of many investigators the indirect cause of ulcer may be syndrome of excessive tension in muscles of the pelvic fundus and functional disorders occurring in the process of defecation. The leading three clinical symptoms are: bleeding, mucus in the stool and feeling of ineffective pressure on rectum. Diagnosis is based on endoscopy and histopathological examination. Other specialist examinations useful in diagnosing the condition itself and its cause in particular patient are: defecography, transrectal ultrasonography and anorectomanometry. There is no consensus as to the treatment of solitary rectal ulcer syndrome currently. Treatment is difficult, lengthy and has poor effectiveness. Conservative treatment includes high fiber diet facilitating defecation as well as gentle oral laxatives, suppositories and enemas with mesalazine or steroids and sukralfat applied topically in form of enemas and ointments or orally. In cases with accompanying functional disorders of constrictor muscles the biofeedback is recommended. Almost all cases involving mucous membrane prolapse or full wall prolapse of the rectum should be treated surgically. Proposed techniques are procedures from the perineal access (Delorme, Altmeier), or abdominal access by laparotomy or laparoscopy (rektopexy, resection procedures). Local excision of ulcer in most cases is ineffective. The careful diagnosis involving both patient’s history and detailed examination, as well as endoscopy, imaging examinations (colonoscopy, transrectal ultrasonography, defecography), and functional examination (anorectomanometry) all are elements essential for therapeutic success. Diagnosing the potential cause of this rare condition is key to its cure.

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