[Hepatobiliary complications of total parenteral nutrition]

Total parenteral nutrition has showed his efficacy in severe digestive diseases. However, infections, metabolic and hepato biliary complications can appear. Aim of this study is to report hepato biliary complications in 200 adult patients, mean age 53 years, treated between 1979 and 1988. Three types of hepato biliary complications occurred in 138 patients initially free of hepato biliary disorders: 1) biochemical hepatic disorders (cholestasis and/or cytolysis) occurred in 58 patients (42%) with mean time of 27 days. In 40% these disorders disappeared after modifications or stop of parenteral nutrition. 2) Jaundice occurred in 9 patients (7%) with mean time of 73 days. Regression of Jaundice is possible only if enteral nutrition is reestablished. Sludge or cholelithiasis occurred in 34 patients (25%) with mean time of 43 days. In five of these patients cholecystectomy must be performed. Literature confirms high frequency of hepato biliary complications in total parenteral nutrition. Occurrence of these complications seems to be related to duration of total parenteral nutrition and to type of nutrition. Most complications decrease when we can stop total parenteral nutrition. Use of lipids in separated perfusion decreases significantly (p < 0.05) biochemical hepatic disorders occurrence. In conclusion, 1) biochemical hepatic disorders are very common, requiring biochemical hepatic tests weekly. 2) Jaundice is rare but serious, requiring stop of parenteral nutrition, and sometimes surgery to reestablish an enteral nutrition. 3) high frequency of cholelithiasis justifies ultrasonographic follow-up, and perhaps preventive cholecystectomy in operation leading total parenteral nutrition.