Increased incidence of biliary sludge and normal gall bladder contractility in patients with high spinal cord injury

Abstract

Background: Patients with spinal cord injury (SCI) have an increased prevalence of gallstones.

Aims: To study prospectively the incidence of gallstones and gall bladder contractility in patients with SCI.

Patients and methods: Thirty six consecutive patients with SCI were studied: 18 patients with SCI above thoracic 10 neuronal segment (> T10) and 18 patients with SCI below T10 (< T10). An equal number each of disease controls (multiple fractures) and healthy controls were also studied. All patients and controls underwent serial ultrasonography to detect development of gallstones and ultrasonographic measurement of gall bladder contractility.

Results: A significantly higher number (9/18) of patients with SCI > T10 developed biliary sludge compared with patients with SCI < T10 (2/18), disease controls (2/18), and healthy controls (1/18) (p < 0.05). No patient developed gallstones. The gall bladder fasting volume was significantly decreased in patients with SCI > T10 (20.56 ml; 95% confidence intervals (CI) 19.74 to 21.38) compared with that in patients with SCI < T10 (27.33 ml, 95% CI 26.17 to 28.49; p < 0.05), disease controls (27.92 ml, 95% CI 26.69 to 29.15; p < 0.05), and healthy controls (28.35 ml, 95% CI 27.25 to 29.45; p < 0.05). Gall bladder contractility was normal in patients with SCI as shown by normal gall bladder residual volume and emptying time.

Conclusions: Patients with SCI above T10 have an increased incidence of biliary sludge and a decreased gall bladder fasting volume. Gall bladder contractility is, however, normal.

Figure 1

: The cumulative probabilities of developing biliary sludge with regard to the time of injury (taken as time 0).Crosses represent SCI above T10, open triangles SCI below T10, closed circles disease controls, and open circles healthy controls.