The purpose of this study was to determine the prevalence of gallstone disease among patients with a spinal cord injury. We identified all patients with a spinal cord injury of greater than 2 weeks' duration who died and underwent an autopsy between 1975 and 1985. These 38 patients with spinal cord injury were age-, sex-, and race-matched with 38 patients without spinal cord injury who underwent an autopsy during the same period. Gallstone disease was significantly more prevalent in patients with spinal cord injury (11 of 38 or 29%) compared to the control population (4 of 38 or 11%) (p less than 0.05; odds ratio of 3.46 with 95% confidence interval of 1.08-11.24). A significant difference in age or level or duration of spinal cord injury was not found between patients with spinal cord injury who had gallstone disease and those who did not. Possible explanations for this threefold increase in risk of gallstone disease among patients with spinal cord injury include abnormal gallbladder motility resulting in stasis, decreased intestinal transit leading to an abnormal enterohepatic circulation, and metabolic changes leading to abnormal biliary lipid secretion.