Splenic Trauma during Colonoscopy: The Role of Intra-Abdominal Adhesions

Abstract

Splenic rupture following colonoscopy is rare, first reported in 1974, with incidence of 1–21/100,000. It is critical to anticipate splenic trauma during colonoscopy as one of the causes of abdominal pain after colonoscopy especially when located in the left upper quadrant or left shoulder. Postoperative adhesions is a predisposing factor for splenic injury, and management is either operative or nonoperative, based on hemodynamic stability and/or extravasation which can be seen on contrast-enhanced CT scan of the abdomen. We present a case of a splenic rupture after colonoscopy in a patient with splenocolic adhesions, requiring splenectomy as definite treatment.

Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

“…138 publications (7 case series and 131 singular case reports) were included of 163 individual patients treated primarily with splenectomy for splenic laceration after colonoscopy 11,14,15,17–19,31,33,34,40,42,45,50,52–176 . Individual patient data are shown in Supplementary Table and presented in comparison to SAE and splenorrhaphy in Table 1.…”

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

“…A review of the recent literature shows that females in their 60s are most affected [ 5 , 8–10 ]. Risk factors for this complication include female sex, age, adhesions from prior abdominal surgery, polypectomy, cardiovascular disease history and use of anticoagulants [ 1 , 7 , 8 , 10 ]. The most common symptom was left upper quadrant abdominal pain [ 3 ].…”

“…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.…”

A Case of Colonoscopy-induced Wunderlich's syndrome in a hemodialysis patient: Coincidence or Link?

“…1 Most published cases following colonoscopy discuss splenic rupture as unusual complication, and may present in 1-21/100000 of cases. 2 To the best of our knowledge SRH has never been described before as a complication of renal cyst rupture in ACKD after colonoscopy. We describe a HD patient with ACKD who developed SRH after colonoscopy along with a discussion of the contributing factors and highlight that HD patients should be under close surveillance after gastrointestinal endoscopy.…”