Hepato-Bilio-Pancreatic Complications of Ulcerative Colitis

  • Giovanni Pompili
  • Alice Munari
  • Alessandro Campari
  • Gianpaolo Cornalba
Chapter
First Online:

Abstract

Extraintestinal manifestations (EIMs) occur in up to 30 % of patients affected by IBD. Hepato-bilio-pancreatic (HBP) complications are one of the most common EIM and primary sclerosing cholangitis (PSC) is by far the most important condition associated. ERCP has been considered for years the gold standard for the diagnosis of PSC. Imaging demonstration of diffuse, multifocal strictures and irregularities involving the medium-sized intrahepatic and/or medium or large-sized extrahepatic ducts is the gold standard for this diagnosis. Nowadays MRCP represents a valid alternative to ERCP depicting bile ducts in their natural degree of distension, using as contrast medium the bile itself. As a consequence, strictures, biliary sludge and stones, which normally may limit studies with contrast medium, do not limit the evaluation of bile ducts with MRCP. Furthermore, MRCP is a less expensive technique, avoiding ionizing radiation and anaesthesia. Other less common HPBs are: autoimmune pancreatitis, IgG4 associated cholangitis, small ducts PSC and CCA. CCA is a fearful and relatively common complication of PSC and the distinction between a benign dominant stricture and CCA in a PSC patient is challenging. Cholangiographic features that suggest CCA include irregular high grade ductal narrowing, rapid progression of the strictures, marked ductal dilatation proximal to strictures, and presence of polypoid lesions.

Keywords

Ulcerative colitis Hepato-bilio-pancreatic (HBP) manifestations Primary sclerosing cholangitis Autoimmune pancreatitis Magnetic resonance cholangiopancreatography 
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Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Giovanni Pompili
    • 1
  • Alice Munari
    • 1
  • Alessandro Campari
    • 1
  • Gianpaolo Cornalba
    • 1
  1. 1.Diagnostic and Interventional RadiologyS. Paolo HospitalMilanItaly

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