Haemorrhagic shock caused by splenic rupture following routine colonoscopy

Pfefferkorn, Urs; Hamel, Christian; Viehl, Carsten T.; Marti, Walter R.; Oertli, Daniel

doi:10.1007/s00384-005-0750-5

Cited by 17 publications

(14 citation statements)

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“…Splenomegaly, splenic disease, inflammation, colon cancer, anticoagulant therapy, and external pressure during colonoscopy, all contribute to a risk of splenic injury [4]. The use of intravenous sedation during colonoscopy has been suggested to increase the risk of splenic injury since patients cannot report pain associated with stretching of the splenocolic ligament [7]. Thereby, technical manoeuvres during colonoscopy such as the α-manoeuvre, straightening of the sigmoid loop, and external pressure on the left hypochondrium may increase the risk of splenic injury [8].…”

Section: Discussionmentioning

confidence: 99%

Shock due to Splenic Injury after Colonoscopy

Nallayici

Groot

Zanten³

et al. 2017

Case Rep Gastroenterol

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Colonoscopy is a common and increasingly performed procedure. It is used both as a diagnostic and therapeutic modality. Splenic injury after colonoscopy is a rare, yet life-threatening complication, most often caused by traction on the splenocolic ligament or excessive manipulation during the procedure. Although non-operative treatment is preferred upon splenic injury, early surgical or radiological intervention may be necessary in specific cases, for example in case of haemodynamic instability. A 71-year-old Caucasian man was referred to our emergency room due to shock after colonoscopy 2 days earlier. A computed tomography scan showed splenic rupture with active intra-abdominal, venous blood loss, and microperforation of the colon. An immediate splenectomy and colon repair were performed through laparotomy. After 6 days, the patient was discharged from hospital in good health. Although splenic rupture is a rare complication of colonoscopy, patients with abdominal pain and/or shock should be checked for complications such as splenic injury and colon perforation.

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Section: Discussionmentioning

confidence: 99%

Shock due to Splenic Injury after Colonoscopy

Nallayici

Groot

Zanten³

et al. 2017

Case Rep Gastroenterol

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“…There is usually abdominal pain, which is generalized or localized to the left upper quadrant [1, 2, 4–15]. Pain may also be felt in the left shoulder or left chest [4, 5, 7, 9–13, 15]. Abdominal examination generally reveals abdominal distention [1, 2, 8, 11, 13].…”

Section: Discussionmentioning

confidence: 99%

“…Patients that are hemodynamically stable can be managed successfully with conservative treatment consisting of observation, IV fluids, and blood transfusions as needed [5, 13]. However, a number of such cases will need surgical intervention [4, 7, 9, 11]. Another option, utilized in our case, is splenic artery embolization.…”

Section: Discussionmentioning

confidence: 99%

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Acute Colonoscopy-Induced Splenic Rupture Presenting to the Emergency Department

Chow

Shih

2013

Case Reports in Emergency Medicine

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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.

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“…Despite its very low incidence, splenic injury at colonoscopy is potentially a life‐threatening condition, more commonly seen in anticoagulated patients or those with splenomegaly, with the proposed mechanisms include direct scope trauma while passing through the splenic flexure or traction over the splenocolic ligament …”

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confidence: 99%