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Purpose: Ketamine is a commonly abused recreational drug in Southeast Asia. There are emerging reports on ketamine abuse causing liver injury and biliary dilatation. This retrospective study aims to investigate the clinical and radiological features of this condition. Methods: A retrospective search in the database of our institute was performed from January 2008 to February 2014 for patients who were ketamine abusers, with deranged liver function and/or epigastric pain, and had computed tomography of the abdomen or magnetic resonance cholangiopancreatography. Patient demographics, clinical data, and radiological findings were reviewed. Results: Twenty-six patients (11 male and 15 female) were included in this study. Eighteen (69 %) patients had fusiform dilatation of the common bile ducts (CBDs) without evidence of intrinsic or extrinsic obstruction, and non-dilated intrahepatic ducts. The degree of CBD dilatation correlated with duration of abuse. In five patients who achieved abstinence, the CBD dilatation showed improvement. Conclusions: Ketamine-related cholangiopathy manifested as fusiform dilatation of the CBD without evidence of obstructive lesions. Severity of CBD dilatation appears to be correlated with the duration of ketamine, and the condition is potentially reversible in abstinent patients.

Inflammatory bowel disease is a chronic, heterogenic, and lifelong illness with a high potential of individual and social disability. A general deterioration of the quality of life in patients with inflammatory bowel disease predominantly stems from localized complications regarding the natural course of the disease. Both Crohn’s disease (CD) and ulcerative colitis (UC) are associated with various kinds of complications. A direct causal relationship exists between disease duration and development of complications. However, CD is frequently related with the formation of fistulae and abscess due to its transmural nature, while UC is often accompanied by the results of severe inflammations such as toxic megacolon. Despite the abundant literature discussing the pathogenesis and treatment of those complications, early detection and intervention for complication is still challenging at present. Therefore, clinical evaluation should precisely characterize the number, location, degree, and feature of the complications. In this chapter, we will review about complications of gastrointestinal tract in patients with inflammatory bowel disease.