E-Newsletter Issue 19: Brainteaser/image of the month
This was seen at the hepatic flexure after withdrawing the colonoscope from the caecum. The reason for the examination was chronic diarrhoea.
What is the most likely underlying diagnosis?
- Irritable bowel syndrome
- Microscopic colitis
- Collagenous colitis
- Crohn’s disease
- Ulcerative colitis
Explanation
The correct answer is C. Although these linear ulcers are due to trauma, the underlying condition is “Collagenous colitis”. Although a small collagen band has also been described in microscopic colitis, the band is thicker (on average 11 µmol compared with 5 µmol) in the former. It is presumed that it is rupturing of the collagen membrane which gives rise to these mucosal tears. Collagen or not, to me it’s a sign that there has been too much pushing!
