Gastrointestinal surgery: solitary rectal ulcer syndrome: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: solitary rectal ulcer syndrome

Sample item

A 30-year-old man with years of straining at stool and feelings of incomplete evacuation has rectal bleeding and mucus. Sigmoidoscopy shows a shallow ulcer on the anterior rectal wall, and defaecating proctography shows internal intussusception. Biopsy shows fibromuscular obliteration of the lamina propria with no malignancy. Which is the first-line management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Fibre, toilet-habit training and biofeedback

Solitary rectal ulcer syndrome results from chronic straining, paradoxical contraction of the puborectalis and rectal prolapse, which cause ischaemic trauma. First-line treatment is conservative: bulk-forming fibre, stopping straining and biofeedback. Surgery is reserved for failures with significant prolapse.

Option by option

  • A. Anterior resection

    Resection is an overtreatment for a benign condition and is reserved for refractory cases.

  • B. Long-term sulfasalazine enemas

    Anti-inflammatory enemas do not address the mechanical cause.

  • C. Fibre, toilet-habit training and biofeedback (correct)

    Correct. Correcting the straining and the dyssynergia addresses the cause.

  • D. Abdominoperineal resection

    Excision of the rectum is not indicated for a benign ulcer.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Fibre, toilet-habit training and biofeedback. Solitary rectal ulcer syndrome results from chronic straining, paradoxical contraction of the puborectalis and rectal prolapse, which cause ischaemic trauma.

Why is "Anterior resection" not the answer?

Resection is an overtreatment for a benign condition and is reserved for refractory cases.

Why is "Long-term sulfasalazine enemas" not the answer?

Anti-inflammatory enemas do not address the mechanical cause.

Why is "Abdominoperineal resection" not the answer?

Excision of the rectum is not indicated for a benign ulcer.

What concept does this question test?

It tests Gastrointestinal surgery: solitary rectal ulcer syndrome in General Surgery. First-line treatment is conservative: bulk-forming fibre, stopping straining and biofeedback. Surgery is reserved for failures with significant prolapse.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: solitary rectal ulcer syndrome?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.