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A 77-year-old woman complained of numerous loose, maroon-colored stools. Laboratory findings revealed
hemoglobin of 6.8 g/dL and a hematocrit of 14.6%. Colonoscopy showed 2 small rectal
polyps, internal hemorrhoids, and a 6.0-cm giant superficial ulceration with protuberant
large vessels on the right anterolateral wall of the rectum 1 cm above the pectinate
line, with well-delimited borders. A large, pulsatile visible vessel that was not
actively bleeding was observed within the ulcer bed (Figure). The visible vessels were injected with 5 mL of a solution of hypertonic saline
with 1/10,000 epinephrine. The patient continued to bleed, requiring the transfusion
of 8 units of packed blood cells, the wide suture ligation of multiple sites of hemorrhage
was performed. Four days later, unexpected massive bleeding reoccurred, and a second
wide suture ligation of the vessel in the base of the ulcer was performed. The patient
survived 10 days after this last procedure. Pathologic findings of biopsies, along
with the clinical history, confirmed a diagnosis of a solitary rectal ulcer syndrome
(SRUS).
FigureRetroflexed sigmoidoscopic view of a giant circumferential solitary ulcer with irregular
borders (white arrows), polypoid lesions, and a 3-mm visible vessel (yellow arrow) in the rectum.
