Acute Colonoscopy-Induced Splenic Rupture Presenting to the Emergency Department

Abstract

Splenic rupture due to colonoscopy is a rarely reported event in the emergency medicine literature. Patients experiencing such an occurrence are likely to report to the emergency department. This paper documents an 84-year-old female who presented to the emergency department with abdominal pain and nausea less than 24 hours following a colonoscopy. An abdominal ultrasound revealed splenomegaly and free fluid. An abdominal computed tomography was significant for a splenic laceration. She underwent radiologic guided embolization and recovered without incident. Emergency medicine physicians need to consider splenic rupture as a differential in patients presenting after colonoscopy with abdominal pain.

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

“…23 publications (5 case series of two or more patients and 18 singular case reports) were included of 30 individual patients primarily treated with splenic artery embolisation for splenic laceration after colonoscopy 27,30–51 . Individual patient data are shown in Supplementary Table and presented in comparison to splenectomy and splenorrhaphy in Table 1.…”

“…23 publications (5 case series of two or more patients and 18 singular case reports) were included of 30 individual patients primarily treated with splenic artery embolisation for splenic laceration after colonoscopy. 27 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 Individual patient data are shown in Supplementary Table S1 and presented in comparison to splenectomy and splenorrhaphy in Table 1 . Most patients were asymptomatic and a only a minority (20%) of colonoscopies were interventional, including biopsy or polypectomy (Supplementary Table S1 ).…”

Colonoscopy-Induced Splenic Injury: An Unusual Complication Warranting Urgent Attention

“…Although generally a safe procedure, colonoscopies are not without risks. The most common complications include intraluminal hemorrhage and colonic perforation with an incidence of 1-2% and 0.1-0.2%, respectively [1,2]. Those two complications are typically associated with biopsies and polypectomies [3,4].…”

“…While the incidence of splenic rupture is estimated at between 0.00005 and 0.017% [4], the true incidence is unknown. Furthermore, this complication may be under-reported due to reluctance to publicize morbidity or because cases are undetected [2]. With the increasing use of colonoscopy, physicians should be cognizant of this potentially fatal complication.…”