Colon (tumor & nontumor)
Other nonneoplastic
Solitary rectal ulcer syndrome

Topic Completed: 1 October 2013

Revised: 9 January 2019, last major update October 2013

Copyright: (c) 2003-2018,, Inc.

PubMed search: solitary rectal ulcer syndrome

Raul S. Gonzalez, M.D.
Page views in 2019: 20,582
Page views in 2020 to date: 10,658
Cite this page: Gonzalez R. Solitary rectal ulcer syndrome. website. Accessed August 14th, 2020.
Definition / general
  • Solitary or multiple ulcerated or polypoid lesions 4 - 10 cm from anal margin
  • Also called mucosal prolapse syndrome (may be a better term since not necessarily solitary, ulcerated or rectal)
  • Uncommon (incidence of 1 per 100,000 per year)
  • Usually third and fourth decade
  • More common in women
  • Rarely in children (Pediatrics 2002;110:e79)
  • Usually in rectosigmoid colon
  • Abnormal function of anal and pelvic floor musculature during defecation, causing rectal mucosal prolapse or intussusception
Clinical features
  • High fiber diet, laxatives, topical steroids
  • Possibly resection
Gross description
  • Well demarcated irregular ulcer(s) on rectal wall
  • Also polypoid, rough, erythematous lesions
  • Mucosal thickening
Gross images

Images hosted on other servers:

Thickened prolapsed
mucosa with surface
erosion (fig 1)

Microscopic (histologic) description
  • Superficial mucosal ulceration and villiform change
  • Crypt hyperplasia and elongation with focal dilation (some glands diamond shaped)
  • Fibromuscular hyperplasia of lamina propria
  • Thickened muscularis mucosae with splayed fibers
  • Ectatic capillaries
  • Minimal inflammation
  • May have inflammatory pseudomembranes
  • Late changes resemble colitis cystica profunda
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Andrey Bychkov, M.D., Ph.D., Kameda Medical Center:

Polypoid shape

Solitary rectal ulcer

Crypt hyperplasia

Disarrayed muscularis mucosa

Images hosted on other servers:

Crypt hyperplasia (fig 2)

Haphazardly arranged benign colonic crypts

Distorted diamond shaped glands

Differential diagnosis
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