Solitary rectal ulcer syndrome and enterocele in a 13-year-old boy

Solitary rectal ulcer syndrome (SRUS) is a rare disorder of childhood, which usually presents with any of the manifestations of anorectal disease, bowel habit alteration and abdominal pain. It is commonly accepted that pathogenesis is associated with disturbances of defecation. We describe a 13-year-old boy with attention deficit hyperactivity disorder (ADHD) and SRUS. He complained of increased stool frequency associated with the passage of blood and mucus, tenesmus, sensation of incomplete defecation and abdominal pain. Circumferential ulcer and flat lesion extending up to the sigmoid colon with typical microscopic findings were revealed upon colonoscopy. Defecography showed an opacified small bowel invaginating into the rectal wall, the pictures consistent with enterocele. Conservative treatment, including reassuring the patient and his mother of the benign nature of the disease, recommendation to avoid straining defecation and use of a high-fiber diet to prevent constipation, was applied. The macroscopic appearance of rectal lesions in SRUS are much more variable than is usually realized. An early diagnosis requires a high index of suspicion both for clinicians and the pathologist.