**2.8 Total parenteral nutrition and cholelithiasis**

Total parenteral nutrition [TPN] impairs enterohepatic circulation and cholecystokinin induced gallbladder contraction resulting in biliary stasis, sludge and stones [41]. The risk of cholelithiasis increase with duration of TPN therapy, and if there is associated ileal resection or disease. Prolonged TPN therapy can lead to gallstones in 43% of children and it increases up to 64% in children with ileal resection or disease [42, 43]. Sludge formation occurs more rapidly in neonates with after a mean duration of 10 days of TPN infusion, as compared to adults where it takes more than 6 weeks.
