A sigmoid stricture

This was found in the sigmoid of a 35 year old lady presenting with abdominal pain and bleeding. She has been taking ibuprofen for her pain. 
WHAT IS THE MOST LIKELY DIAGNOSIS?

■ NSAID induced colitis

Possible but the pain came before starting the ibuprofen

■ Ulcerative colitis

Stricturing and linerar ulcers are not typical for UC

■ Crohn's disease

Most likely and don't forget to add your endoscopic diagnosis to the histology request form!

■ Diverticular stricture

Those rarely ulcerate and are usually MUCH tighter

■ Malignant stricture

Those post-inflammatory polyps are innocent!

explanation

The superficial, linear ulcers are typical of inflammatory bowel disease. Both ulcerative colitis and Crohn's disease can cause stricturing but of course Crohn's is more likely to. Those little nodules are post-inflammatory polyps, covered in normal crypts. In any case of colitis it's important to take a full set of samples, targeting not only areas which are visibly inflamed but also non-inflamed areas. Patchy inflammation is very suggestive of Crohn's disease but if you neglect to sample the non-inflamed areas, you will find that your pathologists will report a continuous colitis which would be more suggestive of ulcerative colitis. After all, they can only report on the samples given to them and may well not read your endoscopy report.