In their article in this issue (Pediatrics 1985;76:905-908), Enzenauer and colleagues propose another complication of total parenteral nutrition in infants, ie, bile sludge obstruction. Their contention is that total parenteral nutrition induced a tenacious, viscid bile that produced a mechanical obstruction of the extrahepatic biliary system in their patient. The evidence supporting this hypothesis is suggestive but not totally convincing. It is true that the infant received prolonged total parenteral nutrition (for 50 days) and that he was fasted during most of the first 2 months of life. Moreover, gallbladder enlargement,1 biliary sludge, and cholelithiasis have been reported in patients receiving total parenteral nutrition.2

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