Objectives of this talk is to discuss hepatobiliary manifestations in pediatric inflammatory bowel disease (IBD), illustrate spectrum of imaging appearances and discuss role of imaging. Hepatobiliary diseases are seen in approximately 18% of children IBD. Four mechanism are implicated in the pathogenesis including sharing a common autoimmune background, for example, primary sclerosing cholangitis, autoimmune hepatitis and IgG4-related cholangitis; intestinal inflammation leading to complications like portal vein thrombosis, liver abscess and granulomatous hepatitis; metabolic impairment causing non-alcoholic fatty liver disease and cholelithiasis; and toxicity of drugs used to treat IBD leading to liver injury or reactivation of indolent infection. PSC is the most common manifestation in children with IBD and seen in 8% of children with IBD. Conversely, almost 80% of children with PSC have associated IBD. The IBD phenotype with PSC is unique and characterized by extensive colitis, rectal sparing and backwash ileitis. Evolution of PSC-IBD is variable in children with some progressing rapidly while others showing relative stability over the span of childhood. MRCP is the main modality of assessment of pediatric PSC and ERCP is reserved only for therapeutic purposes. PSC in children with IBD is detected early, hence imaging features on MRCP are often subtle, mainly characterized by diffuse mild distention of entire biliary tree, periportal thickening/edema, and portal lymphadenopathy. Hepatobiliary manifestations like fatty liver, cholelithiasis and pancreatitis needs to be kept in mind while reviewing MR Enterography in children with IBD.

Acknowledgements

No acknowledgement found.