Splenic Injury After a Colonoscopy: Threading the Scope Carefully in Heritable Connective Tissue Disorders

Abstract

Colonoscopies have reduced colorectal cancer (CRC) burden in the United States, and their utility has expanded to include various diagnostic and therapeutic indications. Complications are seen in up to 1% and increase with age and polypectomy. As colonoscopies become widespread, specific populations seem to be at a much higher risk; notably patients with heritable connective tissue disorders (HCTD). As life expectancy increases, these patients undergo routine screenings and require careful peri-endoscopic care to reduce adverse outcomes. Amongst HCTD, Ehlers-Danlos syndrome (EDS) is commonly implicated, however, no reports of Marfan syndrome (MS) exist. We present a unique case of splenic injury after colonoscopy in a patient with MS. Successful outcomes require early suspicion and emergent surgical evaluation in patients with hemodynamic instability after a colonoscopy. Increased ligament laxity and bowel fragility are the most likely mechanisms. Alternative CRC strategies like fecal immunochemical test (FIT), fecal occult, Cologuard, or virtual colonography can be considered.

Complications of colonoscopy: common and rare—recognition, assessment and management

“…Risk factors include previous abdominal surgeries, splenomegaly, endometriosis, inflammation (inflammatory bowel disease, diverticular disease, pancreatitis) and anticoagulant use 62. Case reports have also been documented in patients with connective tissue disorders such as Ehlers-Danlos syndrome (EDS), specifically vascular EDS, and in Marfan syndrome 63. In such cases, non-invasive testing may be preferable prior to considering colonoscopy and a discussion with the patient about the increased procedural risks is necessary.…”

“… 62 Case reports have also been documented in patients with connective tissue disorders such as Ehlers-Danlos syndrome (EDS), specifically vascular EDS, and in Marfan syndrome. 63 In such cases, non-invasive testing may be preferable prior to considering colonoscopy and a discussion with the patient about the increased procedural risks is necessary.…”