Solitary Rectal Ulcer Syndrome Caused by Homosexual Anal Intercourse

A 21-year-old man was hospitalized with a 3 days history of perianal pain and discomfort. The patient had a history of repeated homosexual anal intercourse within the last 3 months. Physical examination showed no obvious abnormality. The C-reactive protein of the laboratory test result was 77.66 mg/L.

Colonoscopy revealed an ulcerative lesion of approximately 3.0 × 4.0 cm in size in the rectum, with yellow and white moss covering the bottom of the ulcer and congestion of the surrounding mucosa ([Fig. 1]). Inflammatory bowel disease, tuberculosis, Epstein–Barr virus and cytomegalovirus infection, human papillomavirus infection, syphilis, acquired immune deficiency syndrome, hepatitis B, and hepatitis C were excluded during the hospitalization of the patient. The pathological features of mucosal biopsy of this lesion include fibrous atresia of the mucosal lamina propria (red arrows) and thickening of the mucosal muscle layer (green arrows), together with swelling and destruction of crypts (yellow arrows; [Fig. 2]). Based on the patient's medical history and pathological results, the patient was diagnosed with solitary rectal ulcer syndrome (SRUS). The patient was discharged after local symptomatic therapy and treated with topical steroid drugs for 1 month. Five months later, the patient's colonoscopy reexamination showed complete mucosal healing ([Fig. 3]).

Fig. 1 Colonoscopy revealed an ulcerative lesion of approximately 3.0 × 4.0 cm in size in the rectum, with yellow and white moss covering the bottom of the ulcer and congestion of the surrounding mucosa.

Fig. 2 Fibrous atresia of the mucosal lamina propria, thickening of the mucosal muscle layer, and swelling and destruction of crypts (as indicated by the arrows).

Fig. 3 The presentation of intestinal mucosa during the patient's colonoscopy re-examination.

SRUS is a rare benign rectal disease characterized by recurrent inflammation and chronicity and is often accompanied by multiple superficial ulcers on the rectal wall, and sometimes rectal bleeding.[1] SRUS is commonly seen in young men or middle-aged women. The pathogenesis of this disease is not clear, often caused by direct trauma and local ischemia due to the combined action of multiple factors, such as fecal mass compression, finger picking, rectal intussusception, and pelvic floor muscle contradictory contractions. The clinical manifestations of the SRUS include difficulty in defecation, pain in the anus and rectum, incomplete defecation, and mucous and bloody stools.[2] Under endoscopy, it often presents as mucosal congestion and ulcers. Ulcers are often superficial, surrounded by gray white or yellow necrotic tissue, with nodular or granular changes in the surrounding mucosa. The characteristic pathological manifestations include fibrous atresia of the mucosal lamina propria, thickening of the mucosal muscle layer, and changes in crypt structure. This disease needs to be differentiated from ulcerative colitis, ischemic enteritis, Crohn's disease, and rectal tumors. There are many options available for treating SRUS, including conservative treatment, drug therapy, biofeedback, and surgical treatment. Patient health education and behavioral change are often important the first step in treatment.

Author's Contributions

All authors contributed to writing of the manuscript.

Consent

Patient's written consent was obtained for the publication of the case details.

Publikationsverlauf

Artikel online veröffentlicht:
05. März 2025

• References

• 1 Felt-Bersma RJF. Solitary rectal ulcer syndrome. Curr Opin Gastroenterol 2021; 37 (01) 59-65
• 2 Gouriou C, Siproudhis L, Chambaz M. et al. Solitary rectal ulcer syndrome in 102 patients: do different phenotypes make sense?. Dig Liver Dis 2021; 53 (02) 190-195