Individuals with Prader-Willi are prone to skin picking behaviors and, in severe instances, rectal digging. Rectal digging may also be a resultant behavior of solitary rectal ulcer syndrome (SRUS), a rare condition manifested by feelings of incomplete defecation. A 12-year-old male with Prader-Willi Syndrome and developmental delay was admitted to the floor for aggressive and self-injurious behaviors including rectal digging after bowel movements resulting in profuse bleeding and subsequent ingestion. The initial CBC revealed a normocytic anemia and psychiatric treatment was initiated. Upon visualization of rectal prolapse during his stay, GI was consulted and a CBC with differential was repeated with iron studies which revealed an iron deficiency anemia. Fecal calprotectin was elevated to 2,350 and sigmoidoscopy revealed a solitary rectal ulcer. Medical management for the SRUS was initiated with a decrease in rectal digging as well as bleeding. Rectal digging with concomitant Prader-Willi behaviors and SRUS led us to ask the clinical question whether SRUS caused feelings of incomplete defecation and subsequent picking or did acute trauma from a self-injurious behavior cause the formation of a solitary rectal ulcer. In the management of individuals with Prader-Willi, developmental delay, and skin picking behaviors it is important for providers moving forward to recognize SRUS as a possible causative diagnosis for rectal digging. Expanding our differential to include this diagnosis could effectively treat the source and help minimize or eliminate this behavior improving morbidity and psychological stress.
Soppet, Kelsey and Pankaj Vohra. "Rectal Digging Associated with Prader-Willi and Solitary Rectal Ulcer Syndrome: A Case of the Chicken or the Egg." (2021). https://digitalrepository.unm.edu/hsc_2021_pediatric_research/8