title: Primary sclerosing cholangitis in patient with celiac disease complicated by cholecystic empyema and acute pancreatitis.
abstract: BACKGROUND
  The association of celiac disease and sclerosing cholangitis is a well known, although unusual, pathologic feature of autoimmunity.
  
  
  METHODS
  A 64 year old patient presenting with sub-acute cholangitis and pancreatitis, treated with cholecystectomy and endoscopic sphincterotomy. The post-operative course, complicated by cholestatic jaundice, and subsequent clinical complications are described, showing how the diagnosis of sclerosing cholangitis was outlined after the Endoscopic Retrograde Cholangio-Pancreatography (ERCP) and confirmed by liver biopsy. Long term treatment with Ursodeoxycholic acid has gradually normalized bilirubin values, while cholestasis enzymes are gradually decreasing. After 18 months bleeding from oesophageal varices ensued, which was controlled through endoscopic ligation.
  
  
  CONCLUSIONS
  The diagnosis of primary sclerosing cholangitis should be taken into account when cholangitis is associated with other immunity derangements and segmentary dilatations of the intra-hepatic bile ducts, but no dilatation of the main bile duct is noticed at imaging or endoscopy. Recovery of hepatic function should be always attempted before bringing the patient to surgery, in order to avoid postoperative hepatic decompensation.
authors.forename: P
authors.initials: P
authors.lastname: Piccolboni
authors.forename: E
authors.initials: E
authors.lastname: Ragone
authors.forename: A
authors.initials: A
authors.lastname: Inzirillo
authors.forename: R
authors.initials: R
authors.lastname: Utili
mesh_terms: D000208:Acute Disease; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications*; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002763:Cholecystectomy; D002764:Cholecystitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery; D006801:Humans; D041781:Jaundice, Obstructive / Q000188:drug therapy / Q000209:etiology; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid