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ENDOSCOPIC SUBMUCOSAL DISSECTION FOR A CHALLENGING RECTAL LESION IN A SYMPTOMATIC CHILD WITH SOLITARY RECTAL ULCER SYNDROME
Ahmad a. Madkour
*1,2, Amr El Fouly
1, ahmad h. salem
2, badreya abd allah
2, Mahkoud khamees
2, Mohamed G. Saqr
2, Hassan Atalla
31Gastroenterology, Helwan University, Helwan, Cairo, Egypt; 2Egypt General Authority for Healthcare, CAIRO, --- Select ---, Egypt; 3Mansoura University Gastroenterology Surgical Center, Mansoura, Egypt
Solitary rectal ulcer syndrome, which often affects the elderly and is rarely present in children, is an uncommon benign disease of the rectum. Surgery could be offered for refractory polypoidal lesions, but mostly with unsatisfactory outcomes. Herein, we present a dedicated ESD for a challenging, large, non-homogenous, polypoidal rectal lesion occupying more than 3/4 of the circumference, with multiple overlying ulcerated areas in a 13-year-old child. En bloc dissection was finally accomplished despite a greatly challenging procedure with significant submucosal fibrosis and repeated attacks of massive bleeding. Tips and tricks for managing such challenges were explained in detail.
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