A patient with abdominal pain and cramps is marked for an ileostomy. The colonoscopy shows lesions that balloon out through the wall of the intestine. What condition does this indicate?

The presence of lesions that balloon out through the wall of the intestine is indicative of Crohn's disease. This condition is characterized by transmural inflammation, which can lead to the formation of fistulas, strictures, and abscesses, as well as the appearance of "cobblestoning" due to ulceration and scarring. The lesions described often result in complications that may necessitate surgical interventions, such as an ileostomy.

While ulcerative colitis can also cause abdominal pain and has associated lesions, it typically affects only the mucosal layer of the colon and does not feature the same transmural involvement or significantly ballooning lesions. Diverticulitis, on the other hand, involves inflammation of diverticula, which are pouches in the colon, rather than lesions that cause wall protrusion throughout the intestine. Diverticulosis refers to the presence of diverticula without inflammation, which does not match the symptomatology or endoscopic findings described. This makes Crohn’s disease the most fitting diagnosis in this context.