Purpose or Case Report: A 12 year old hispanic male with a past medical history of rectal prolapse presented to the ED from the pediatrician with a Hgb of 4.5 on outpatient lab work. The patient’s mother reports a history of constipation, staying in the bathroom for long periods of time and straining. Additionally the patient has been fatigued and pale for the last year with intermittent bloody diarrhea for the last 3 years.
Inpatient testing included defecography which showed evidence of rectal prolapse. MR enterography revealed wall thickening and hyperenhancement of the rectosigmoid colon, consistent with infectious/inflammatory etiology. Colonoscopy with biopsy was performed and histopathology results were consistent with solitary rectal ulcer syndrome.
The patient was successfully treated conservatively with dietary changes, topical medications and education about bathroom habits.

Solitary rectal ulcer syndrome (SRUS), first described in 1829, is an uncommon, benign disease characterized by clinical history, imaging (including defecography, and MR enterography), colonoscopy and diagnosed by histopathological findings. With an annual prevalence of 1 in 100,000, SRUS is most commonly found in young adults, but also seen in pediatric and geriatric populations.
Clinical presentation usually includes a history of prolonged straining, constipation, lower abdominal pain, rectal bleeding, mucous discharge and rarely rectal prolapse. Solitary rectal ulcer syndrome is actually a misnomer as only 40% of cases present with ulcers; even fewer present with a solitary ulcer. The etiology is not completely understood but is likely multifactorial.
Diagnosis of SRUS is often missed or delayed due to low clinical suspicion, inadequate rectal biopsy or failure to recognize histopathological features of the disease. It is therefore important to recognize solitary rectal ulcer syndrome and the diagnostic features and maximize the likelihood of accurately diagnosing SRUS early on.
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