Association of cholecystitis and parenteral nutrition.

Total parenteral nutrition (TPN) is a well-established means of nutritional support in the critically ill patient who is unable to maintain adequate oral intake. A complication of long-term parenteral nutrition is gallbladder disease. Cholecystitis is often difficult to diagnose in patients with multisystem disease and has a dour prognosis when there is delay in diagnosis and operative treatment. An awareness of the risk factors for cholecystitis, including TPN, in the critically ill patient is the sine qua non of early diagnosis. If cholecystitis is suspected, the diagnosis may be established by ultrasonography, tomography, and scintigraphy. Immediate cholecystectomy is the treatment of choice.