Correlation of prolonged fasting and gall bladder sludge formation after emergency G. I. surgery

Abstract

Background: After emergency laparotomy due to some intestinal pathology patient are kept fasting to rest the bowel so that repaired pathology could get the proper time for healing. And during this period body’s nutritional requirement are replenished either by total parenteral nutrition or other intravenous fluids containing glucose and electrolytes. The major complication of TPN is liver disease that most commonly include steatosis, cholestasis, Cholelithiasis. Development of cholestasis, biliary sludge, and gall stone are due to loss of enteric stimulation and not directly linked to TPN. The effect of fasting on the composition of hepatic and gall bladder bile in humans has already been studied and this shows gall bladder bile is significantly supersaturated after fasting and can lead to sludge formation.Methods: A prospective study was conducted in department of general surgery, a rural tertiary care centre in north india (UPUMS, Saifai, Etawah, Uttar Pradesh, India) between January 2016 to May 2017. Study included all the patients in emergency who were planned for emergency laparotomy based on inclusion and exclusion criteria.Results: Of the 116 patients 83 (71.5%) were male patients and 33 (28.4%) were female patients, aged between (23 - 64 years). Total no. of sludge positive patients after 7 days was 39 (33.6%). Sludge positive female patients were 17 in 33 (51.1%) and sludge positive male patients were 22 out of 83 male patients (26.5%). Out of 53 patients of duodenal and gastric surgery 28 patients (52.8%) developed sludge formation. Out of other 63 surgeries only 10 (15.8%) patients developed sludge. Out of 39 sludge positive patients 28 (71.7%) were alone from group of duodenal and gastric surgery.Conclusions: our study supports that the prolonged restriction of oral food intake in patient operated on the gastrointestinal tract that results in decreased contractility due to absence of food stimulated gall bladder contraction, may be an important cause to sludge development in our group of patients.