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Infliximab for the treatment of entero-vesical fistula in Crohn's disease

and biliary strictures who responded to immunosuppressive therapy. Retrospectively, we identified 4 pts with pancreatic mass and biliary sclerosis who were successfully treated with immunosuppression. All were males, age 33 to 71 years. 3 presented with abdominal pain and jaundice and one with painless jaundice. One patient had a remote history of retroperitoneal fibrosis responsive to steroids. All had cholestatic liver enzyme elevation. Serum amylase and lipase were normal. CT scan showed generalized pancreatic enlargement in one pt, mass in the head of the pancreas in 2 and enlargement of the body and tail of pancreas in the 4. ERCP showed intra and extrahepatic biliary strictures in all. Biopsies and brushings from the strictures were negative for malignancy in all. 1 pt underwent a Whipple procedure and the histopathology of the resected pancreas showed fibrosis and chronic inflammatory cells. 2 pts had a negative cytology at fine needle aspiration of the pancreatic mass. The 4 pt had an open biopsy of the mass which showed fibrosis with mononuclear inflammation. All pts had episodes of cholangitis. Liver biopsy was performed in 2 pts and showed findings of chronic obstructive cholangiopathy. All 4 pts responded to immunosuppression with resolution of biliary strictures. 3 pts had resolution of the pancreatic mass and 1 pt had a Whipple procedure. 2 pts were treated with Methotrexate. One showed a good initial response but later developed recurrence of biliary strictures and was treated successfully with Prednisone and Azathiaprine. The other two pts were treated successfully with Prednisone and Azathiaprine. Prednisone was tapered over 4–5 months. Mean follow up has been 6 months. Patients with pancreatic pseudotumor and biliary sclerosis present with cholestatic jaundice, pancreatic mass and intra and extrahepatic biliary strictures at ERC . Pancreatic mass raises the concern of malignancy and it is mandatory to exclude this. A good response to immunosuppressive regimen with resolution of pancreatic mass and biliary strictures is indicative of the benign nature of the disease. The ideal dosage and duration of therapy is not clear. An autoimmune etiology has been implicated for the enlargement of pancreas or the pancreatic mass.