2021 Pediatric Research Forum Poster Session

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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.



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