BACKGROUND--The aetiology and pathology of rectal prolapse and solitary rectal ulcer are poorly understood. AIMS--To examine the full thickness rectal wall in these two conditions. METHODS--The pathological abnormalities in the surgically resected rectal wall were studied from nine patients with solitary rectal ulcer syndrome, 11 complete rectal prolapse, and nine cancer controls. Routine haematoxylin and eosin and Van Gieson staining for collagen were performed. RESULTS--The rectal wall from solitary rectal ulcer syndrome specimens was thickened compared with complete rectal prolapse and controls. The major difference was in the muscularis propria (2.2 v 1.1 v 1.2 mm, medians, p < 0.005) and particularly the inner circular muscular layer, and to a lesser extent the submucosal and outer longitudinal muscular layers. Some solitary rectal ulcer syndrome specimens showed unique features such as decussation of the two muscular layers (four of nine), nodular induration of inner circular layer (four of nine) and grouping of outer longitudinal layer into bundles (three of nine); these were not seen in complete rectal prolapse or control specimens. CONCLUSIONS--These features, which resemble the features of high pressure sphincter tissue, may be of aetiological importance, and suggest a different pathogenesis for these two disorders. Excess collagen was seen in both disorders, was more severe in solitary rectal ulcer syndrome specimens, and probably reflects a response to repeated trauma.
展开▼
机译：背景-对直肠脱垂和孤立性溃疡的病因和病理学了解甚少。目的-在这两种情况下检查直肠全壁厚度。方法-从9例孤立性直肠溃疡综合征，11例直肠完全脱垂和9例癌症对照患者中研究了手术切除的直肠壁的病理异常。常规苏木精和曙红和Van Gieson胶原染色。结果-与完全直肠脱垂和对照相比，孤立性直肠溃疡综合征标本的直肠壁增厚。主要区别在于固有肌层（2.2 v 1.1 v 1.2 mm，中位数，p <0.005），尤其是内部圆形肌层，以及程度较小的粘膜下层和外部纵向肌层。一些孤立的直肠溃疡综合征标本表现出独特的特征，例如两个肌肉层的堆积（九个中的四个），内圆形层的结节硬结（九个中的四个）和外部纵向层成束（三个九个）的分组；在完整的直肠脱垂或对照标本中看不到这些。结论-这些特征类似于高压括约肌组织的特征，可能在病因学上很重要，并提示这两种疾病的发病机理不同。在这两种疾病中都发现了过多的胶原蛋白，在孤立的直肠溃疡综合征样本中更为严重，并且可能反映了对反复创伤的反应。
展开▼
