Delayed Presentation of Splenic Rupture After Endoscopy in a Patient With Hemophilia A: Case Report and Review of the Literature

Abstract

An 88-year-old female presented with dyspnea on exertion and severe anemia. Colonoscopy was unremarkable and the patient was transfused with packed red blood cells prior to discharge. The patient returned 2 weeks later with severe abdominal pain, hypotension, and anemia. Computed tomography revealed splenic hematoma and hemoperitoneum. She bled from the surgical sites during emergent splenectomy and work-up revealed hemophilia A. We present, to our knowledge, a case of the longest reported delay in presentation of post-colonoscopy splenic rupture and the first in a patient with hemophilia A.

A Very Rare Cause of Splenic Injury: Splenic Hematoma Following a Diagnostic Upper Endoscopy (Esophagogastroduodenoscopy) and Biopsy of Gastric Ulcer

“…It has been suggested that bowing of the endoscope along the greater curvature of the stomach can cause avulsion of the splenic or short gastric vessels. The strain can be so great as to tear the splenic capsule, and may be magnified by insufflation of the stomach [2,3,6,7]. Direct splenic injury can also result from manipulation of the endoscope, especially when larger caliber scopes such as the Olympus GF-UM3 and TJFV10 are utilized [2].…”

“…Though many commonly acknowledged adverse events such as difficulty swallowing and abdominal discomfort are typically mild, splenic injury is an exceedingly rare and serious complication. While iatrogenic endoscopic splenic injury has been infrequently described following endoscopic retrograde cholangiopancreatography (ERCP) and colonoscopy, only a few reported cases have been attributed to EGD [1][2][3][4]. Sharp abdominal pain, hemodynamic instability, and signs of occult hemorrhage can indicate splenic rupture.…”

Iatrogenic Severe Splenic Injury after Colonoscopy

“…Most patients with splenic injury present within 24 hours after procedure [ 1 – 12 ]. However, some patients may present 10 to 14 days after procedure [ 2 , 7 , 13 , 14 ] with the longest time reported from procedure to presentation being two weeks [ 2 ]. Left upper quadrant abdominal pain is the most commonly reported presenting symptom [ 6 , 7 ].…”

“…In some cases, patients may be completely asymptomatic [ 6 , 7 ]. Clinical signs of hypotension, anemia, and elevated white blood cell count may be present [ 2 , 4 , 6 ].…”

“…Bleeding and colonic perforation are the most commonly described complications following colonoscopy [ 1 – 3 ]. Splenic injury is also a complication of colonoscopy, with only about 100 reported cases worldwide, making it a rare complication of colonoscopy [ 1 , 2 ]. Here, we present a patient who developed significant splenic injury (grade III) [ 4 ] with hemoperitoneum as a complication of diagnostic colonoscopy.…”