Abstract: Introduction: Solitary rectal ulcer syndrome (SRUS) is a great masquerader and misdiagnosis has serious implications for the patient. Methods and materials: We reviewed 21 patients with histopathologically proven SRUS at our tertiary care teaching hospital in South India. Results: Bleeding per rectum and constipation with passage of mucous were the common symptoms at presentation. Endoscopy revealed a single ulcer in 16 (76.19%), multiple ulcers in 5 (23.8%), polypoidal lesion in 1 (4.7%) and circumferential ulcer in 2 (9.5%). 3 (14.28%) patients had rectal ulcer resembling malignancy on endoscopy such as everted edge 1 (4.7%) and hard growth 2 (9.5%). Endoscopic biopsy from one such patient was reported as adenocarcinoma for which abdominoperineal resection was done. The final histopathological report of the resected specimen was SRUS. Conclusion: SRUS is a misnomer with a potential for misdiagnosis as carcinoma. Under reporting may result in progression of disease and over reporting is disastrous for low rectal lesions.