A 42-year-old woman was seen in the Gastroenterology Department since January 2005 for presenting with scant rectorrhagia at the end of bowel movements together with tenesmus and anal pain of two years' evolution. The patient had no family or personal history of interest and did not follow any regular medical treatment. Physical examination revealed only an indurated area on the left lateral wall of the rectum. A complete blood test was carried out, which was strictly normal. In view of this finding, it was decided to perform a colonoscopy, finding two millimetric polyps in the rectal ampulla, internal haemorrhoids (one of them prolapsed) and on the left lateral side of the rectal ampulla an erythematous and slightly raised area of approximately 2 x 2 cm, with geographic borders and an indeterminate appearance, from which biopsies were taken. The differential diagnosis of inflammatory bowel disease (ulcerative colitis), steroid ulcer and solitary rectal ulcer syndrome was initially raised. Pathological anatomy showed mucosal thickening, with elongation and distortion of the glands and an oedematous lamina propria with a large amount of collagen and fibroblasts, all compatible with the diagnosis of solitary rectal ulcer syndrome. Anorectal manometry was performed and showed a slightly reduced maximum tolerable rectal volume and a minimally prolonged balloon expulsion time.

