A rare case of multiple colonic ulcers revealed by hematochezia

Introduction. The colonic pathology associated with the administration of nonsteroidal anti-inflammatory drugs is vast and includes inflammation, ulcerations and sometimes strictures. It is important to identify the NSAIDs-induced alterations in the colon in order to differentiate them from other pathologies and to avoid treatment errors. The objective of this paper is to present a post-NSAIDs colopathy revealed by lower digestive bleeding – hematochezia. Material and methods. A 68 years old patient under treatment with NSAIDs is hospitalized for hematochezia. Laboratory tests, upper and lower digestive endoscopy are performed and multiple colonic ulcers are identified. Results. Following the investigations, the suspicion of post-NSAIDs colonic ulcers is raised and a differential diagnosis with inflammatory bowel disease is sought by taking multiple biopsies. The histopathological examination shows ischemic necrosis, with no pathognomonic elements linked to Crohn’s disease. Conclusions. The peculiarity of this case resides in the importance of identifying the NSAIDs-induced pathology and differentiating it from other pathologies to prevent treatment errors. Associating multiple ulcers in NSAIDs pathology is rare and often misdiagnosed as Crohn's disease. Keep in mind the importance of the histopathologic exam, which excluded the inflammatory bowel disease in a patient with inconclusive inflammatory biological evidence.