Introduction In general, the colonic mucosa is macroscopically normal in collagenous colitis, although minor, non-specific abnormalities may be found. Significant endoscopic abnormalities, «mucosal tears» representing longitudinal mucosal lacerations, have been reported in a few patients with collagenous colitis (1). The colonoscopist should aware that the risk of perforation is likely to be increased when mucosal tears are present.A 56-year-old female patient was referred to the outpatient clinic with 6 weeks history of profuse watery diarrhoea. Her significant past medical history includes colonic polyps and polypectomy in 2000 and her last colonoscopy in 2003 was normal. Her drug history includes alendronic acid 70 mg once a week, hormone replacement therapy patches, solifenacin 5 mg once a day and loperamide 2 mg as required. Her initial blood investigations including FBC, Urea & electrolytes, LFT, TFT, inflammatory markers, coeliac serology & stool cultures were normal. Her colonoscopy revealed a mucosal tear at the splenic flexure and the biopsies confirmed collagenous colitis.

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Abstract PTU-010 Figure

Conclusion The colonoscopy usually reveals a normal mucosa or mild mucosal edoema & usually biopsies required to confirm the diagnosis. The mucosal tears on endoscopic insufflation are not uncommon with collagenous colitis.A postulated mechanism for the mucosal lacerations in collagenous colitis might be the rigid character of the collagen containing subepithelium, possibly in combination with endoscopic insufflation,leading to stretching of the mucosa and subsequent tearing (2)

Disclosure of Interest None Declared

References

1. Colonic mucosal tears in collagenous colitis. Wickbom A, Lindqvist M, Bohr J, Ung KA, Bergman J, Eriksson S, Tysk C.SourceDivision of Gastroenterology, Department of Medicine, Orebro University Hospital, Orebro, Sweden.

2. Collagenous colitis with mucosal tears on endoscopic insufflation: a unique presentation. M Cruz-Correa, F Milligan, F M Giardiello, et al. Gut 2002 51: 600 doi:10.1136/gut.51.4.600