Solitary rectal ulcer
This is becoming a more commonly diagnosed
problem. Classically, it takes the form of an ulcer on the anterior wall of the
rectum. In this form it must be differentiated from a rectal carcinoma or
inflammatory bowel disease, particularly Crohn’s disease. In recent years, it
has been appreciated that the ulceration may heal, leaving a polypoid
appearance. A variety of explanations as to its cause has been suggested,
including persistent trauma by sexual malpractices. However, recent
proctographic studies indicate that the cause may be due to a combination of
internal intussusception or anterior rectal wall prolapse, and an increase in
intrarectal pressure. This combination of factors is usually due to chronic
straining as a result of constipation. The histological appearances confirm
the diagnosis (Morson) and they are similar to the appearances of biopsies from
a full-thickness overt rectal prolapse. The condition, although benign, is
difficult to treat. Symptomatic relief from bleeding and discharge may sometimes
be achieved by preventing the internal prolapse by an abdominal rectopexy. In
rare cases rectal excision may be required.