Soliter Rektal Ülser Sendromu
Özet
Soliter Rektal Ülser Sendromu (SRUS), genellikle 50 yaş altı bireylerde görülen, nadir ve kronik seyirli iyi huylu bir hastalıktır. Hastalık; dışkılama sırasında aşırı ıkınma, pelvik taban bozuklukları ve paradoksik puborektalis kasılması gibi mekanik ve iskemik travmalar sonucu gelişir. Klinik olarak hastalar en sık rektal kanama, mukus deşarjı, dışkılama zorluğu ve tam boşalamama hissi ile başvururlar. Tanı sürecinde sigmoidoskopi ve biyopsi altın standart kabul edilirken; lamina propriada fibromüsküler obliterasyon tipik bir histopatolojik bulgudur. Tedavi yaklaşımı multidisipliner olup, yaşam tarzı değişiklikleri ve lifli diyetle başlar; dirençli vakalarda ise biyofeedback terapisi, topikal sukralfat uygulamaları veya argon plazma koagülasyon (APK) gibi endoskopik yöntemler tercih edilir. Cerrahi müdahale, genellikle rektal prolapsus eşlik eden veya konservatif tedavilere yanıt vermeyen sınırlı bir hasta grubunda değerlendirilir. Hastalığın nüks oranı yüksek olduğundan, her hastaya özel ve adım adım ilerleyen kişiselleştirilmiş tedavi planları büyük önem taşımaktadır.
Solitary Rectal Ulcer Syndrome (SRUS) is a rare and chronic benign disorder that primarily affects individuals under the age of 50, characterized by mechanical and ischemic trauma resulting from excessive straining during defecation, pelvic floor dysfunction, and paradoxical puborectalis contraction. Patients most frequently present with clinical symptoms such as rectal bleeding, mucus discharge, difficulty defecating, and a sense of incomplete evacuation, while diagnosis relies on sigmoidoscopy and biopsy as the gold standard, with fibromuscular obliteration in the lamina propria serving as a typical histopathological finding. The therapeutic approach is multidisciplinary, beginning with lifestyle modifications and high-fiber diets; for resistant cases, biofeedback therapy, topical sucralfate applications, or endoscopic methods like argon plasma coagulation (APC) are preferred, whereas surgical intervention is reserved for a limited group of patients with associated rectal prolapse or those unresponsive to conservative treatments. Due to the high recurrence rate of the disease, personalized and stepwise treatment plans tailored to each patient are of great importance.
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