Ibrahim Falih Noori
MB,ChB, CABS, FICS, DS, Assist. Prof., Department of Surgery, College of Medicine, Basrah University

Solitary rectal ulcer (SRU) is rare benign disease of poorly understood etiology. The term solitary ulcer is misnomer because the lesion is solitary in only 20% of patients and ulcer present in 40% of the patients only. The lesion has various sizes and shapes that ranges from mucosal erythema to single or multiple ulcers to ulcer-nodular lesion or could be a polypoid or fungating mass. The estimated incidence of solitary rectal ulcer is about 1:100000 annually. Males and females are affected equally with slight predominance toward female patients. The disease can affect children and elderly patients also, although rare. The disease involves straining during defecation, a sense of incomplete evacuation, digital evacuation of the rectum, rectal prolapse and occasionally passing of blood and mucus by rectum. Clinical awareness confirmed by flexible sigmoidoscopy and biopsy are main diagnostic tools. Furthermore, the colonoscopic findings may mimic that of rectal cancer and inflammatory bowel disease and the histopathological results are inadequate due to fibrotic rectal mucosa. Treatment of solitary rectal ulcer depends on the severity of the condition with conservative measures, bowel regimen, and change of life style for mild cases and surgical procedure for sever refractory cases.