The prevalence and natural history of gallstones in spinal cord injured patients.
BACKGROUND
Individuals with a spinal cord injury are at increased risk for the development of gallstones. Because these patients cannot reliably manifest classic symptoms of biliary colic, they may be more likely to present with advanced biliary complications than patients with intact abdominal innervation. The natural history of gallstones in spinal cord injured patients has not been described.


METHODS
All spinal cord injured patients seen at the Seattle Veterans Affairs Medical Center from January 1, 1993, to December 31, 1997 were included in the study. For each patient, the presence or absence of gallstones had been determined previously through screening abdominal ultrasonographic evaluations. Pertinent demographic information was obtained from medical records and patient interviews. Patients with gallstones were followed until death, cholecystectomy, or the conclusion of the study, and the annual incidence of biliary complications and patients requiring a cholecystectomy were determined. The prevalence of gallstones was established by studying the subset of patients seen at the Seattle Spinal Cord Injury Unit from January 1, 1995 to December 31, 1997.


RESULTS
Among the spinal cord injured patients, 31% either had gallstones or had undergone a cholecystectomy at some point after their injury. Increasing age, female gender, and greater severity of injury were risk factors for the formation of gallstones. Over the first 5 years after the diagnosis of gallstones, the annual incidence of cholecystectomy or biliary complications was 6.3% and 2.2%, respectively.


CONCLUSIONS
Spinal cord injured patients are at increased risk for the development of gallstones. Patients with gallstones are at an increased risk for the development of biliary complications compared with neurologically intact patients, but the magnitude of this risk does not warrant prophylactic cholecystectomy.
Moonka
R
R
Department of Surgery, The Seattle Division of the Veterans Affairs Puget Sound Health Care System, The University of Washington School of Medicine, USA.
Stiens
S A
SA
Resnick
W J
WJ
McDonald
J M
JM
Eubank
W B
WB
Dominitz
J A
JA
Stelzner
M G
MG
D016009:Chi-Square Distribution; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D014463:Ultrasonography