Patients with longstanding inflammatory bowel disease, such as ulcerative colitis and Crohn disease, are at risk of a wide range of extra-intestinal manifestations, highlighting the multisystemic nature of these conditions. The extra-intestinal manifestations include both benign and malignant disease of the hepatobiliary system and potentially debilitating disease of the musculoskeletal, genitourinary, pulmonary, nervous, and cutaneous systems. These extra-intestinal conditions may follow a course unrelated to the activity of the bowel disease and, on occasion, may be the initial presenting complaint. For these reasons, it is important for the radiologist to recognize them. This article reviews the imaging features of some of the more established extra-intestinal manifestations, using various imaging modalities, and highlights areas where imaging plays a key role in the management of these extra-intestinal conditions.