SOLİTER REKTAL ÜLSER SENDROMU: GİZLENEN ETYOLOJİ, BASİT TEDAVİ

Giriş: Soliter rektal ülser sendromu (SRÜS) pelvik taban hastalığına bağlı geliştiği düşünülen nadir bir patolojidir. Ayrıca hastaların birçoğunda parmakla rektal ampulla boşaltımı mevcuttur. Çalışmadaki amaç medikal ve cerrahi tedavi uygulamaksızın, öncelikli olarak yaşam tarzı değişiklikleri ve pelvik taban kaslarını güçlendirecek egzersizlerle birlikte hastalıktaki düzelmeyi incelemektir. Gereç ve Yöntem: 2014-2017 yılları arasında; klinik özellikler, rektosigmoidoskopi bulguları,histopatolojik bakı, defekografi, dinamik manyetik rezonans görüntüleme ve anorektal manometri gibi yöntemlerle SRÜS tanısı konmuş 29 olgumuzun verileri retrospektif olarak incelenmiştir. Uygun hastalara medikal tedavi verilmemiş sadece özel beslenme, makat ve pelvik taban egzersizlerini içeren yaşam tarzı değişiklikleri önerilmiştir. Parmakla ampulla boşaltımı yapmamaları kesinlikle istenmiştir. Hastaların 1 ve 4. ay rektoskopi kontrolleri yapılmıştır. Hastalara verilen ortalama takip süresi 4-6 aydır. Bulgular: Ortalama yaş 38.4±4’dür, kadın oranı %59’ dur. 20 olguda lezyon rektum ön duvarda, 2 olguda rektum arka duvarda, 7 olguda ön-yan bileşkede ve tüm olgularda soliter ülser şeklinde izlenmiştir. Lezyonların anal girimden uzaklığı 5.7±2.2 (5-11) cm arasındadır. Olgularda konstipasyon (%85), rektal kanama (%65), mukuslu dışkılama (%55) en sık semptomlardır. 4. Ay kontrol rektosigmoidoskopi’de 6 (%21) hastada ülserin tamamen iyileştiği, 16 (%55) hastada ülserde belirgin küçülme olduğu görülmüştür. 7(%24) hastada ise ülser boyutunda belirgin fark izlenmemiştir. Sonuç: Ciddi kanama, derin ülser ve prolapsu ile birlikte olmayan ve histopatolojik malignite bulguları içermeyen SRÜS tedavisinde yaygın ve kabul edilen görüş, öncelikle destek ve medikal tedavi ile hastalığın kontrol altına alınmasıdır.Çalışmamızda SRÜS’lu olgularımızın büyük bir çoğunluğunda medikal ve cerrahi tedavi uygulanmaksızın destek tedavi yöntemleri ile semptomlarda düzelme saptanmıştır.

SOLITARY RECTAL ULCER SYNDROME: CONFIDENTIAL ETIOLOGY, SIMPLE TREATMENT

Introduction: Solitary Rectal Ulcer Syndrome (SRUS) is a rare pathology which is usually thought to be associated with pelvic floor disorders. Also, rectal ampulla discharge by the finger is available in most patients. The aim of the study was to examine the improvement of the disease along with lifestyle changes and exercises to strengthen the pelvic floor muscles without providing medical treatment. Material and Method: 29 patients with SRUS which diagnosed based on clinical features, findings on proctosigmoidoscopy and histological examination, imaging investigations including defecating proctography, dynamic magnetic resonance imaging, and anorectal functional studies including manometry were examined retrospectively between 2014-2017. Lifestyle changes including appropriate diet, breech, and pelvic floor exercises have been proposed to appropriate patients without medical treatment. Patients were absolutely asked not to discharge the ampulla with the finger. The patients underwent rectosigmoidoscopy at the 1. and 4. months.The mean follow-up period was 4-6 months. Results:The mean age was 38.4 ± 4 and the rate of women was 59%. The lesion was located in the anterior, posterior wall, anterior-lateral junction of the rectum in 20, 2, 7 patients respectively. In all cases, it was observed as a single ulcer. The distance of the lesions from the anal line is between 5.7 ± 2.2 (5-11) cm. Constipation (85%), rectal bleeding (65%), mucus stooling (55%) were the most common symptoms. The ulcer was completely healed in 6 (21%) patients at the 4th-month follow-up rectosigmoidoscopy. There were a marked reduction in ulceration in 16 (55%) patients. There were no significant differences in ulcer size in 7 (24%) patients. Conclusion: In SRUS without severe bleeding, deep ulcer and prolapse,the disease should be controlled with support and medical treatment. In our study, symptoms improved with supportive treatment without medical and surgical treatment in most of the cases with SRUS.

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