BACKGROUND: Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC), are chronic inflammatory disorders of the gastrointestinal tract with increasing incidence worldwide. Though primarily affecting the digestive system, IBD can lead to extraintestinal manifestations, including rare respiratory complications. CASE PRESENTATION: In our case report, we present the case of a 56-year-old woman with a history of UC and bronchiectasis who developed bronchial stenosis, manifesting as worsening cough and bronchospasm. Initial treatment with corticosteroids and biologic therapy was unsuccessful. The patient subsequently underwent bronchoscopic dilatation interventions, improving her bronchial stenosis and respiratory symptoms. Maintenance therapy with corticosteroids was initiated, while gentamicin was locally administered during the procedures to control infection due to high-load colonization by Pseudomonas. CONCLUSION: This case underscores the importance of early diagnosis and a multidisciplinary treatment approach to managing complex IBD-related respiratory involvement. Future research on targeted therapies and personalized management strategies is needed to improve outcomes for patients with these rare complications.