Colonoscopy is the primary screening procedure for colorectal cancer and car− ries very low risk of complications (be− tween 0.3 % and 0.35 %) [1]. It is estimated that 1.69 million colonoscopies are per− formed each year in the USA alone [2]. The most common complications are in− traluminal gastrointestinal bleeding and colonic perforation [1]. Infrequently, he− moperitoneum occurs, mostly involving damage to the spleen. We present a case of hemoperitoneum following colonosco− py without splenic injury. A 59−year−old female presented to our emergency department following a syn− copal episode 12 hours after an unre− markable screening colonoscopy. Despite minor abdominal discomfort noted after the procedure, she resumed her normal activities. Pertinent history included a prior appendectomy. Besides pallor and minimal abdominal tenderness to palpa− tion, physical exam was within normal limits. Laboratory tests showed a hemo− globin concentration of 10.4 g/dL and a hematocrit of 28.8 %. Leukocyte count, electrolytes, blood urea nitrogen, and creatinine were normal. Stool was guaiac negative. An abdominal radiograph ex− cluded pneumoperitoneum (l " Fig. 1). Computed tomography (CT) scans of the abdomen and pelvis showed moderate amounts of free fluid demonstrating a density level suggestive of blood. The spleen appeared normal and there was no free air or extravasation of contrast from the bowel (l " Fig. 2 a, b). She was monitored for further bleeding and was subsequently discharged after 6 days. Intra−abdominal hemorrhage, a rare com− plication of colonoscopy, is most com− monly reported in conjunction with splenic injury. Other documented causes of hemoperitoneum after colonoscopies include a torn mesenteric vessel, a rup− tured epiploic appendix, and a necrosed intestinal leiomyosarcoma [3 ± 5]. Due to the lack of other findings, it was speculat− ed that the etiology in this case was a torn mesenteric vein. Intra−abdominal adhe− sions from her appendectomy could have contributed. Endoscopy_UCTN_Code_CPL_1AJ_2ABHemoperitoneum after colonoscopy Fig. 1 Abdominal radiograph centered at the diaphragm ex− cludes the presence of pneumoperitoneum.