Biliary sludge: the sluggish gallbladder

High rate of complicated idiopathic gallstone disease in pediatric patients of a North American tertiary care center

“…The rate found in our study was similar to that of adult patients [18][19][20] . Complications such as pancreatitis and dilatation of the common bile duct occurred in 25%, which is more than expected [21,22] . The high prevalence of complications can be attributed to the high proportion of chronically-and severely-ill patients hospitalized at Saint Justine Hospital.…”

Biliary Sludge: Can we Avoid Punishing Gallbladder by Srivastava Regimen of Integrated Approach of Medicine?

“…5 The main pathogenic mechanism involved in sludge formation is probably gallbladder dismotility, and in selected patients measures aimed to maintain adequate gallbladder contractions has been shown to effectively prevent sludge development. 6 Gallbladder hypomotility found in patients of prolonged total parenteral nutrition and of high spinal cord injury predisposes formation of biliary sludge. The clinical course of biliary sludge ranges from complete resolution to progression to formation of gallstones.…”

“…However, several clinical conditions are associated with a particularly high prevalence of biliary sludge, including pregnancy, rapid weight loss, total parenteral nutrition (TPN), octreotide therapy, bone marrow or solid organ transplantation. 6 Ceftriaxone is one of the most commonly used 3rd generation parenteral cephalosporins because it has wide spectrum of anti-microbial activity, a long plasma half-life that allows once-daily administration and it can even penetrate the blood brain barrier. Ceftriaxone could have potential complications and these are biliary sludge or biliary lithiasis, and even urinary tract precipitation, but these complications may be reversible upon discontinuation of Ceftriaxone.…”

When Is Pancreatitis Considered to Be of Biliary Origin and What Are the Implications for Management?

“…Biliary sludge is a mixture of particulate matter which precipitates from bile, can consist variously of cellular, proteinaceous and bacterial debris and may also contain cholesterol monohydrate crystals, calcium bilirubinate and other calcium salts embedded in mucin [11,14] . Biliary sludge has been reported as causing acute pancreatitis in 3.1% of cases [15] , although whether this is due to sludge per se or to associated microlithiasis is difficult to judge, and is of course frequently observed in patients with acute pancreatitis secondary to alcohol.…”

“…The term 'secondary biliary sludge' has been used to describe sludge in situations associated with reduced gallbladder contractility, such as pregnancy, prolonged fasting, rapid weight loss, total parenteral nutrition and following abdominal surgery [14] . In fact biliary sludge is a frequent finding in patients with peritonitis irrespective of the cause.…”