Gallstone Disease in Patients with Severe Short Bowel Syndrome Dependent on Parenteral Nutrition

An increased incidence of gallbladder disease is seen in patients receiving long-term parenteral nutrition (PN). Stasis is thought to play a key role in the development of gallbladder sludge and gallstone formation. The highest incidence of gallbladder disease, by previous reports, is seen in patien...

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Published in:	JPEN. Journal of parenteral and enteral nutrition Vol. 13; no. 5; pp. 461 - 464
Main Authors:	Manji, Nasrullah, Bistrian, Bruce R., Mascioli, Edward A., Benotti, Peter A., Blackburn, George L.
Format:	Journal Article
Language:	English
Published:	Thousand Oaks, CA Sage Publications 01-09-1989 SAGE Publications ASPEN
Subjects:	Adolescent Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cholelithiasis - etiology Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition Female Humans Intensive care medicine Malabsorption Syndromes - therapy Male Medical sciences Mesenteric Vascular Occlusion - surgery Parenteral Nutrition - adverse effects Parenteral Nutrition, Total - adverse effects Retrospective Studies Short Bowel Syndrome - etiology Short Bowel Syndrome - therapy Human Surgery Lithiasis Digestive diseases Gallbladder Short bowel syndrome Long term Resuscitation Parenteral administration Feeding Incidence
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Summary:	An increased incidence of gallbladder disease is seen in patients receiving long-term parenteral nutrition (PN). Stasis is thought to play a key role in the development of gallbladder sludge and gallstone formation. The highest incidence of gallbladder disease, by previous reports, is seen in patients with terminal ileal disease or resection. Since PNdependent patients with severe short bowel syndrome secondary to mesenteric vascular accident have both gallbladder stasis and massive small bowel resection, a retrospective study was undertaken to evaluate the incidence of symptomatic gallbladder disease in this group. Of 11 patients followed over 9 years, five met the inclusion criteria of less than 60 cm of bowel remaining, receiving PN for longer than 6 months and the initial presence of a gallbladder. All five patients developed symptomatic gallbladder disease manifested by cholecystitis or pancreatitis. Factors contributing to gallbladder stasis included poor oral intake and use of anticholinergic and analgesic drugs. Gastric hypersecretion indirectly contributed to decreased oral intake as a means to minimize stool output. As these patients often require several laparotomies during the initial hospitalization, consideration should be given to performing prophylactic cholecystectomy, especially when the potential mortality and morbidity of emergent cholecystectomy done for symptomatic gallbladder disease is taken into account. (Journal of Parenteral and Enteral Nutrition 13:461-464, 1989)
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0148-6071 1941-2444
DOI:	10.1177/0148607189013005461