Abstract
Patients with spinal cord injury (SCI) have an increased prevalence of cholelithiasis. The goal of this study was to clarify the presentation and management of symptomatic gallstone disease in patients with SCI. We performed a retrospective study of presentation of gallstone complications in patients with SCI who underwent cholecystectomy for complications of gallstone disease. The West Roxbury Veterans Administration Medical Center SCI registry (605 patients) was searched for patients who had undergone cholecystectomy more than 1 year after SCI (35 patients). Gallbladder disease profiles for the 35 patients undergoing cholecystectomy for complications of gallstone disease were prepared, including demographics, clinical presentation, diagnostic studies, operative and pathologic findings, and postoperative complications. All patients were white. Thirty-four were male and the mean age was 50 years (range 35 to 65 years). The majority of patients (66%) complained of right upper quadrant abdominal pain, even those patients with SCI at high (i.e., cervical) levels. Of the 35 patients in our study group, 22 (63 %) had biliary colic and chronic cholecystitis, nine (26%) had acute cholecystitis (gangrenous cholecystitis in two), two (6%) had choledocholithiasis symptoms or cholangitis, and two (6%) had gallstone pancreatitis. Major perioperative morbidity occurred in two (6%) of the 35 patients (pulmonary embolus; intraoperative hemorrhage), and there were no deaths. In the great majority of patients with SCI, cholelithiasis presents with chronic pain and not with life-threatening complications. Our findings suggest that presentation is no more acute in patients with SCI than in the general population. Characteristic symptoms and signs are not necessarily obscured by SCI injury, regardless of the level.
Similar content being viewed by others
References
Diehl AK. Epidemiology and natural history of gallstone dis- ease. Gastroenterol Clin North Am 1991;20:l-19.
Bennion LJ, Knowler WC, Mott DM, Spagnola AM, Bennett PH. Development of lithogenic bile during puberty in Pima Indians. N Engl J Med 1979;300:873–876.
Friedman LS, Roberts MS, Brett AS, Marton KI. Manage- ment of asymptomatic gallstones in the diabetic patient: A de- cision analysis. Ann Intern Med 198R;109:913–919.
Acalovscji MV, Blendea D, Pascu M, Georoceanu A, Badea RI, Prelipceanu M. Risk of asymptomatic and symptomatic gallstones in moderately obese women: A longitudinal follow- up study. Am J Gastroenterol 1997;92:127–131.
Ransohoff DF, Gracie WA, Wolfenson LB, Neuhauser D. Prophylactic cholecystectomy or expectant management for silent gallstones: A decision analysis to assess survival. Ann In- tern Med 1983;99:199–204.
Apstein MD, Dalecki-Chipperfield K. Spinal cord injury is a risk factor for gallstone disease. Gastroenterology 1987;92:966–968.
Tandon RK, Jain RK, Garg PK. Increased incidence of biliary sludge and normal gallbladder contractility in patients with high spinal cord injury. Gut 1997;41:682–687.
Ketover SR, Ansel HJ, Goldish G, Roche B, Gebhard RL. Gallstones in chronic spinal cord injury: Is impaired gallblad- der emptying a risk factor? Arch Phys Med Rehabil 1996; 77:1136–1138.
Moonka R, Stiens SA, Eubank WB, Stelzner M. The presen- tation and results of biliary surgery in a spinal cord injured population. Am J Surg 1999;178:246–250.
Moonka R, Stiens SA, Resnick WJ, McDonald JM, Eubank WB, Dominitz JA, Stelzner MG. The prevalence and natural history of gallstones in spinal cord injured patients. J Am Coll Surg 1999;189:274–281.
Bateson MC. Gallbladder disease and cholecystectomy are in- dependently variable. Lancet 1984;2:621–624.
Grade WA, Ransohoff DF. The natural history of silent gall- stones: The innocent gallstone is not a myth. N Engl J Med 1982;3O7:798–800.
National Institutes of Health. Consensus development con- ference on gallstones and laparoscopic cholecystectomy. Am J Surg 1993;165:390.
Heruti RJ, Bar-On Z, Gofrit O, Weingarden HP, Ohry A. Acute acalculous cholecystitis as a complication of spinal cord injury. Arch Phys Med Rehabil 1994;75:822–824.
Neumeyer LA, Bull DA, Mohr JD, Putnam CW. The acutely affected abdomen in paraplegic spinal cord injury patients. Ann Surg ]990;212:561–566.
Charney KJ, Juler GL, Comarr AE. General surgery problems in patients with spinal cord injuries. Arch Surg 1975;110:1083–1088.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tola, V.B., Chamberlain, S., Kostyk, S.K. et al. Symptomatic gallstones in patients with spinal cord injury. J Gastrointest Surg 4, 642–647 (2000). https://doi.org/10.1016/S1091-255X(00)80115-8
Issue Date:
DOI: https://doi.org/10.1016/S1091-255X(00)80115-8