Ultrasound semiotics of solitary rectal ulcer

AIM: to develop ultrasound semiotics of solitary rectal ulcer (SRU).PATIENTS AND METHODS: fifty-eight patients with a histologically verified SRU were included in the retrospective study. All patients underwent colonoscopy and transrectal ultrasound (TRUS). Changes in rectal wall detected by TRUS were compared with colonoscopy data.RESULTS: On TRUS SRU is represented by a significantly thickened rectal wall (median thickness of the rectal wall in the region of SRU is 9 (7–10) mm and 5 (4–6) mm outside, p < 0.001), most often with a predominance of muscular and submucosal layers (46/58, 79%). The structure and echogenicity of these layers are changed: the connective tissue layer is visualized in muscular layer (51/58, 88%), submucosal layer is hypoechogenic (47/58, 81%), boundaries between rectal wall layers are faded (50/58, 86%). Ulcers in SRU are characterized by presence of areas where the mucous layer cannot be traced (sensitivity 100%, specificity 95%), its extent is comparable to extent of ulcers detected on colonoscopy (p = 0.528). Polypoid SRU is characterized by local thickening of the mucosa (sensitivity 89%, specificity 95%). TRUS location of the SRU in height (p = 0.644) is comparable with colonoscopy data.CONCLUSION: the study determined general ultrasound signs of SRU and made it possible to differentiate macroscopic forms of SRU from each other with TRUS.