AN UNUSUAL CAUSE OF INTESTINAL OBSTRUCTION DUE TO RECTAL STRICTURE CAUSED BY SOLITARY RECTAL ULCER AND ITS TRANSANAL TREATMENT: A NOVEL APPROCH
Abstract
Solitary rectal ulcer (SRU) syndrome is characterized by rectal bleeding, tenesmus, and difficult evacuation. SRU is a rare cause of intestinal obstruction. Our Objective is to report a case of intestinal obstruction due to stenosis caused by solitary rectal ulcer and its transanal treatment. Case: A 32-year-old male patient with a biopsy-proven solitary rectal ulcer had complaints of rectal bleeding and tenesmus for 4 years. Evacuation proctography reveals no internal prolapsus but prolonged and incomplete evacuation. Colonoscopies show a stenosis in the rectum at the level 8 cm from the anal verge. The passage was minimal. After conservative treatment, under the transanal approach, the stenosis is dilated. The EEA 34 plus stapler (Auto-Suture, New Haven, USA)., which was also used in the Longo procedure, was placed and the area with stenotic ulcer was resected in the form of a ring. No postoperative complication occurred. The patient was sent to proctology department for biofeedback retraining. Although there were rectal complaints in the controls over the years, obstruction and ulcer were not observed. Conclusion: Rectal strictures caused by SRU may rarely cause intestinal obstruction. In terms of sphincteric function, resection with a transanal stapler may be a novel approach in such cases. It was concluded that research should be conducted on this subject by creating case series.
References
- Baskonus I, Maralcan G, Gokalp A, Sanal I(2001) Solitary rectal ulcer syndrome: an unusual cause of rectal stricture. Case report. Chirurgia Italiana. 2001 Jul-Aug;53(4):563-566. PMID: 11586577.
- Durando R, Palestini N, Campi M, Rispoli P.(1989) L'ulcera solitaria del retto. Descrizione di un caso [Solitary ulcer of the rectum. Description of a case]. Minerva Dietol Gastroenterol. Jan-Mar;35(1):51-4. Italian. PMID: 2657495.
- Gabra HO, Roberts JP, Variend S, Shawis RN.(2005)Solitary rectal ulcer syndrome in children. A report of three cases. Eur J Pediatr Surg. Jun;15(3):213-6. doi: 10.1055/s-2004-821180. PMID: 15999319.
- Gruber M, Füglistaler I, Zettel A, Fox M, Manz M.(2016) An Unusual Cause of Rectal Stenosis. Case Rep Gastroenterol. Aug 9;10(2):406-409. doi: 10.1159/000448065. PMID: 27721725; PMCID: PMC5043168.
- Longo A.(1998) Treatment of hemorrhoid disease by reduction of mucosa and hemorrhoid prolapse with a circularsuturing device: A new procedure. Proc 6th World Cong Endosc Surg 1998; 7:777-84
- Laughlan K, Jayne DG, Jackson D, Rupprecht F, Ribaric G. (2009)Stapled haemorrhoidopexy compared to MilliganMorgan and Ferguson haemorrhoidectomy: A systematic review. Int J Colorectal Dis 2009; 24:335-44.
- Özcan, B., Erdoğan, O. (2019). Stapler Hemoroidopeksi? de Anokutanöz Hattın 4 Kadrandan Traksiyonu Avantaj Sağlıyor mu?. Akdeniz Tıp Dergisi, 5(2), 290-295.
- Perrakis E, Vezakis A, Velimezis G, Filippou D. (2005)Solitary rectal ulcer mimicking a malignant stricture. A case report. Rom J Gastroenterol. 2005 Sep;14(3):289-91. PMID: 16200242.
- Takeda A, Imaseki H, Okazumi S, Shimada H, Takayama W, Hayashi H, Suzuki T, Ochiai T.(2000) A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis. J Gastroenterol.35(1):56-9. doi: 10.1007/pl00009977. PMID: 10632543.
- Tjandra, J. J., Fazio, V. W., Church, J. M., Lavery, I. C., Oakley, J. R., & Milsom, J. W. (1992). Clinical conundrum of solitary rectal ulcer. Diseases of the colon & rectum, 35, 227-234.
SOLİTER REKTAL ÜLSERİNİN NEDEN OLDUĞU REKTAL DARLIKTAN KAYNAKLANAN İLGİNÇ BİR BAĞIRSAK TIKANIKLIĞI VE TRANSANAL TEDAVİSİ: YENİ BİR YAKLAŞIM
Abstract
Soliter rektal ülser (SRÜ) sendromu rektal kanama, tenesmus ve zor rektal boşalım ile karakterizedir. SRÜ bağırsak tıkanıklığının nadir bir nedendir. Bu çalışmada soliter rektal ülserin neden olduğu stenoza bağlı bağırsak tıkanıklığı olgusunu ve bunun transanal tedavisini sunma amaçlandı. Olgu: Biyopsi ile soliter rektal ülseri tanısı alan 32 yaşındaki erkek hastanın 4 yıldır rektal kanama ve tenesmus şikayeti vardı. Çekilen proktografisinde internal prolapsusu olmadığını ancak uzun süreli ve yetersiz rektal boşalımı ortaya koyuyordu. Kolonoskopide rektumda anal kanaldan 8 cm uzaklıkta pasaja zor izin veren darlık olduğu saptandı. Konservatif tedavi sonrasında transanal yaklaşımla darlık genişletildi. Longo prosedüründe de kullanılan EEA 34 plus stapler (Auto-Suture, New Haven, USA) yerleştirildi ve stenotik ülserli bölge halka şeklinde rezeke edildi. Postoperatif komplikasyon gelişmedi. Hasta biofeedback eğitimi için proktoloji departmanının kontrolüne gönderildi. Yıllar içinde yapılan kontrollerde rektal şikayetleri olsa da obstrüksiyon ve ülser gözlenmedi. Sonuç: SRÜ bağlı rektal darlıklar bağırsak tıkanıklığına ender olarak neden olabilir ve sağlam bir anatomi ve sfinkterik fonksiyon açısında bu gibi olgularda transanal stapler ile rezeksiyon yeni bir yaklaşım olabilir. Tedavi güvenli ve minimal invaziftir. Bu konuda olgu serileri oluşturularak araştırma yapılması gerektiği kanısına varıldı.
Ethical Statement
Hastadan Helsinki Bildirgesine uygun geniş yazılı onam alınmıştır. Bu olgu sunumu2 5th European Congress of Trauma and Emergency Surgery- İstanbul 2002 Kongresinde poster olarak İngilizce sunulmuştur.
References
- Baskonus I, Maralcan G, Gokalp A, Sanal I(2001) Solitary rectal ulcer syndrome: an unusual cause of rectal stricture. Case report. Chirurgia Italiana. 2001 Jul-Aug;53(4):563-566. PMID: 11586577.
- Durando R, Palestini N, Campi M, Rispoli P.(1989) L'ulcera solitaria del retto. Descrizione di un caso [Solitary ulcer of the rectum. Description of a case]. Minerva Dietol Gastroenterol. Jan-Mar;35(1):51-4. Italian. PMID: 2657495.
- Gabra HO, Roberts JP, Variend S, Shawis RN.(2005)Solitary rectal ulcer syndrome in children. A report of three cases. Eur J Pediatr Surg. Jun;15(3):213-6. doi: 10.1055/s-2004-821180. PMID: 15999319.
- Gruber M, Füglistaler I, Zettel A, Fox M, Manz M.(2016) An Unusual Cause of Rectal Stenosis. Case Rep Gastroenterol. Aug 9;10(2):406-409. doi: 10.1159/000448065. PMID: 27721725; PMCID: PMC5043168.
- Longo A.(1998) Treatment of hemorrhoid disease by reduction of mucosa and hemorrhoid prolapse with a circularsuturing device: A new procedure. Proc 6th World Cong Endosc Surg 1998; 7:777-84
- Laughlan K, Jayne DG, Jackson D, Rupprecht F, Ribaric G. (2009)Stapled haemorrhoidopexy compared to MilliganMorgan and Ferguson haemorrhoidectomy: A systematic review. Int J Colorectal Dis 2009; 24:335-44.
- Özcan, B., Erdoğan, O. (2019). Stapler Hemoroidopeksi? de Anokutanöz Hattın 4 Kadrandan Traksiyonu Avantaj Sağlıyor mu?. Akdeniz Tıp Dergisi, 5(2), 290-295.
- Perrakis E, Vezakis A, Velimezis G, Filippou D. (2005)Solitary rectal ulcer mimicking a malignant stricture. A case report. Rom J Gastroenterol. 2005 Sep;14(3):289-91. PMID: 16200242.
- Takeda A, Imaseki H, Okazumi S, Shimada H, Takayama W, Hayashi H, Suzuki T, Ochiai T.(2000) A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis. J Gastroenterol.35(1):56-9. doi: 10.1007/pl00009977. PMID: 10632543.
- Tjandra, J. J., Fazio, V. W., Church, J. M., Lavery, I. C., Oakley, J. R., & Milsom, J. W. (1992). Clinical conundrum of solitary rectal ulcer. Diseases of the colon & rectum, 35, 227-234.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Medical Education |
| Journal Section | Case Reports |
| Authors | |
| Publication Date | December 27, 2023 |
| Submission Date | October 5, 2023 |
| Published in Issue | Year 2023 Volume: 2 Issue: 3 |
