Solitary rectal ulcer syndrome: a radiologic diagnosis?

The solitary rectal ulcer syndrome (SRUS) is an uncommon condition in which a solitary area of discrete ulceration is typically found on the anterior wall of the rectum. Between 1981 and 1983, we collected 8 pathologically proven cases of SRUS in which barium enema examinations had been performed (7 double-contrast, 1 single-contrast). Seven patients had rectal bleeding. On the original x-ray report, 4 cases were thought to be normal, but the pathologic tissue had been removed endoscopically in 2 of these cases prior to the radiologic study. The other 4 cases were thought to be abnormal, although the specific diagnosis of SRUS was not suggested in any case. In a blinded rereading of these 8 cases randomly interspersed with 29 other non-SRUS cases, however, the films were interpreted in light of recent radiologic experience with this condition. The same 4 cases were still thought to be normal. In the remaining 4 cases, barium enemas revealed thickened, edematous valves of Houston (3 cases) and a submucosal mass adjacent to the anal verge (1 case). The diagnosis of SRUS was suggested in all 4 cases with only 1 false-positive diagnosis due to a rectal stricture in a patient with endometriosis. Although barium enemas may be normal in patients with SRUS, the presence of thickened, edematous valves of Houston, particularly in a young patient with rectal bleeding, should suggest this condition.