PEDIATRICS Vol. 76 No. 6 December 1985, pp. 992-993
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On the Bile Sludge Syndrome or Is Total Parenteral Nutrition Cholestasis a Surgical Disease?

JOHN R. LILLY MD1 and RONALD J. SOKOL MD2

1 Department of Surgery, University of Colorado School of Medicine, 4200 E 9th Ave, Denver
2 Department of Pediatrics, University of Colorado School of Medicine, 4200 E 9th Ave, Denver

In their article in this issue (Pediatrics 1985;76:905-908), Enzenauer and colleagues propose another complication of total parenteral nutrition in infants, ie, bile sludge obstruction. Their contention is that total parenteral nutrition induced a tenacious, viscid bile that produced a mechanical obstruction of the extrahepatic biliary system in their patient. The evidence supporting this hypothesis is suggestive but not totally convincing. It is true that the infant received prolonged total parenteral nutrition (for 50 days) and that he was fasted during most of the first 2 months of life. Moreover, gallbladder enlargement,1 biliary sludge, and cholelithiasis have been reported in patients receiving total parenteral nutrition.2