Biliary sludge may be a precursor of gall stones in man. The aim of this study was to determine the incidence of biliary sludge in a prospective study of 36 patients admitted to the intensive care unit for longer than two days. The presence of biliary sludge was determined by ultrasonography. Biliary sludge developed in 17 patients (47%), after a mean of 5.5 days in the intensive care unit. Patients who developed biliary sludge spent longer in the intensive care unit (14.2 d (1.3)), compared with patients who did not (8.3 d (1.4)); (p = 0.003). Ten of the patients with biliary sludge had a recognised risk factor: total parenteral nutrition (five), abdominal surgery (two), or both (three). All neurosurgical patients (four) who required total parenteral nutrition developed biliary sludge. Seven patients with biliary sludge had no previously recognised risk factor, five of whom had severe head trauma or neurosurgery. In conclusion, biliary sludge develops frequently and rapidly in patients admitted to an intensive care unit. Neurosurgical procedures are associated with biliary sludge formation. (Sludge is commonly associated with the development of cholestatic liver biochemistry.)
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