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 mani fest classic symptoms of biliary colic, they may be more likely to present with advanced biliary complications than patients with intact abdominal inn ervation. The natural history of gallstones in spinal cord injured patients has not been described. Study Design: All spinal cord injured patients seen at the Seattle Veterans Affairs Medical Center from January 1, 1993, to December 31, 1997 were inc luded in the study. For each patient, the presence or absence of gallstones had been determined previously through screening abdominal ultrasonographi c evaluations. Pertinent-demographic information was obtained from medical records and patient interviews. Patients with gallstones were followed unti l death, cholecystectomy, or the conclusion of the study, and the annual in cidence of biliary complications and patients requiring a cholecystectomy w ere determined. The prevalence of gallstones was established by studying th e subset of patients seen at the Seattle Spinal Cord Injury Unit from Janua ry 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. Increa sing age, female gender, and greater severity of injury were risk factors f or the formation of gallstones. Over the first 5 years after the diagnosis of gallstones, the annual incidence of cholecystectomy or biliary complicat ions was 6.3% and 2.2%, respectively. Conclusions: Spinal cord injured patients are at-increased risk for the dev elopment of gallstones. Patients with gallstones are at an increased risk f or the development of biliary complications compared with neurologically in tact patients, but the magnitude of this risk does not warrant prophylactic cholecystectomy. (J Am Cell Surg 1999;189:274-281. (C) 1999 by the America n College of Surgeons).