Splenic rupture following colonoscopy

Abstract

Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insufflation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.

Acute Colonoscopy-Induced Splenic Rupture Presenting to the Emergency Department

“…Being aware of this diagnosis and being able to identify the symptoms of such a patient can lead to a faster, life-saving diagnosis. Most patients with a colonoscopy-induced splenic rupture present with the typical symptoms of a trauma-induced splenic rupture within 24 hours of their colonoscopy [1–14]. However, some patients do have delayed presentation several days later [12].…”

“…The most common complications are bleeding and intestinal perforation with incidence rates of approximately 1-2% and 0.1-0.2%, respectively [1, 2]. An extremely rare complication is splenic rupture, with an estimated rate of 0.004% [2].…”

Milzruptur nach Vorsorgekoloskopie

“…an der Milzkapsel [1,2,3,7]. Auch externer Druck und Manipulationen während der Koloskopie stellen einen prädisponierenden Faktor für eine Milzverletzung dar [5,6,8,11,12]. Diese Faktoren ließen sich auch für den vorliegenden Fallbericht in Form einer erschwerten Koloskopie und einer stattgehabten Laparotomie vor 30 Jahren feststellen.…”

“…Das therapeutische Management hängt von der Klinik des Patienten ab [6,12]. Bei hämodynamischer Stabilität ist ein konservativer Therapieansatz mit engmaschiger Kontrolle auf einer Wachstation indiziert.…”

Medico-legal considerations in a case of splenic injury that occurred during colonoscopy

“…1 It is an invasive test, nonetheless, even used for purely diagnostic purposes, and it is not without complications, the most common being perforation of the intestinal wall (0.34e2.14%) and bleeding (1.8e2.5%), while the less common include visceral lesions such as pneumothorax, pneumoperitoneum, acute appendicitis and retroperitoneal abscess. 2,3 Another, exceptionally rare but potentially lethal complication of the procedure is represented by splenic lesions, particularly when these occur in the absence of intestinal wall lesions. This complication was first described in 1974 by Werry and Zhener and only a few dozen such cases have been reported in the international literature so far (with 68 cases known to date, see Table 1).…”