Conservative Treatment of Splenic Haematoma After Colonoscopy: A Case Report

Abstract

Colonoscopy is a routine procedure performed worldwide, nevertheless, a small risk of splenic injury, often underestimated , is still present. As a matter of fact, the diagnosis may be delayed, leading to a rising risk of morbidity and mortality. This paper describes a case of conservative treatment of colonoscopy-associated splenic injury. A 57-year-old woman presented with worsening pain in the upper left abdominal quadrant; she had radiation therapy to the ipsilateral subscapular region, and a diagnostic colonoscopy 18 hours earlier. The computed tomography (CT) scan revealed splenic laceration without signs of hemoperitoneum. Because of the hemodynamic stability of the patient, successful conservative treatment and serial controls of the blood and hemodynamic parameters were adopted. Even if rare splenic injury during colonoscopy is associated with significant morbidity and mortality. A high degree of clinical suspicion is essential to achieve a prompt diagnosis as well as an early surgical evaluation. The nonoperative approach is usually taken in patients with no intraperitoneal bleeding, a closed subcapsular haematoma and a stable hemodynamic status.

Diagnostic nightmare: intra-intestinal bleed masks intra-abdominal bleed after colonoscopy

“…In some cases, with the iatrogenic splenic injury of less severe grade, conservative management with IV fluids, blood transfusions and intensive care unit monitoring have been adequate to manage the patient [ 6 , 7 , 10 , 12 ]. In those cases, the patient did not have severe bleeding or had a small hematoma that resolved with conservative treatment and observation.…”

“…The other option in therapy for milder splenic lacerations involves splenic artery embolization to stop intra-abdominal bleeding [ 5–7 ]. Surgery was required to resolve the symptoms in most cases where the splenic rupture was Grade III and above with an accompanying large hematoma [ 1 , 10 , 12 ].…”