背景:孤立性直肠溃疡综合征(SRUS)是一种与排便障碍相关的良性直肠疾病,具有多因素病理和不同表现,内窥镜检查,和组织病理学。差异和逐步管理重叠的诊断困境,从保守疗法开始,在保守方法失败的情况下进行重复手术。
目的:本研究旨在观察临床,内窥镜,下消化道出血患者SRUS的组织学特征。
方法:该研究在消化内科进行,医学教学研究所,2018年10月至2020年4月,白沙瓦夫人雷丁医院。书面知情同意后,通过非概率方便采样,纳入了年龄在15至70岁之间出现下消化道出血的257名患者(149名男性和108名女性)。社会人口统计细节记录在预先设计的形式中。用结肠镜CF200Z进行结肠镜检查,奥林巴斯东京,Japan,并注意到发现。疑似病变被放大,用0.2%靛蓝染色,从溃疡的中部和边缘进行活检,送去做组织病理学检查.所有数据在SPSS-20中记录和分析。计算定量变量的平均值与SD,并计算定性变量的频率和百分比。用卡方检验检验显著性,P值<0.05被认为具有统计学意义。
结果:在17例(6.6%)下消化道出血患者中发现了SRUS,男性占57%(n=11)。直肠周围出血,便秘,粘液分泌物,腹痛,贫血是常见的临床表现。孤立性病变,溃疡,直肠前位置是最常见的内窥镜检查结果。带有胶原蛋白的固有层,溃疡,地穴失真,炎性浸润是常见的组织病理学发现。
结论:SRUS是一种良性排便障碍,通常表现为下消化道出血,便秘,紧张,和腹痛。它需要一种保守管理的逐步方法,医疗管理,生物反馈,手术是最后的手段。
BACKGROUND: Solitary rectal ulcer syndrome (SRUS) is a benign rectal condition associated with defecation disorder that has multifactor pathologies and variable findings on presentation, endoscopy, and histopathology. A diagnostic dilemma with an overlap of differentials and step-wise management that starts with conservative therapies and goes up to repeated surgeries in case of failure of the conservative approach.
OBJECTIVE: This study aims to observe clinical, endoscopic, and histological features of SRUS in patients presenting with lower gastrointestinal bleeding.
METHODS: The study was conducted at the Department of Gastroenterology, Medical Teaching Institute, Lady Reading Hospital Peshawar from October 2018 to April 2020. After written informed consent, 257 patients (149 males and 108 females) from ages 15 to 70 who presented with lower GI bleeding were included via non-probability convenient sampling. Sociodemographic details were recorded in a pre-designed proforma. A colonoscopy was performed with the Colonoscope CF200 Z, Olympus Tokyo, Japan, and findings were noted. Suspected lesions were magnified, dyed with 0.2% indigo carmine, biopsied from the middle and edges of the ulcer, and sent for histopathology. All data were recorded and analyzed in SPSS-20. The mean with SD was calculated for quantitative variables, and frequency and percentages were calculated for qualitative variables. The chi-square test was used to check the significance, and a p-value of <0.05 was considered statistically significant.
RESULTS: SRUS was found in 17 (6.6%) patients with lower GI bleeding, with a male predominance of 57% (n=11). Perirectal bleeding, constipation, mucous discharge, abdominal pain, and anemia were common clinical findings. Solitary lesions, ulceration, and anterior rectum location were the most common endoscopy findings. Obliterated lamina propria with collagen, ulceration, crypt distortion, and inflammatory infiltrates were common histopathological findings.
CONCLUSIONS: SRUS is a benign defecation disorder commonly presenting with lower GI bleeding, constipation, straining, and abdominal pain. It needs a stepwise approach with conservative management, medical management, biofeedback, and surgeries as a last resort.