Rare complication of colonoscopySplenic injury following colonoscopy is rare but can be fatal and easily over looked. 1 The first case was reported in 1974 by Wharry and Zehner. 2 To date 34 cases have been reported, 29 of which appear in an English language publication. 3-33 In most cases, the patient presented within 24 h of the procedure. Delayed presentation is less common but can occur. [6][7][8][9] Colonoscopy is a relatively safe procedure with few complications. The most frequent complications are bleeding after polypectomy 1% and perforation 0.1%. 1 Other less commonly reported complications include pneumothorax, pneumomediestinum, volvulus, hernia incarceration, retroperitoneal abscess and acute appendicitis. [33][34][35][36][37][38] A 73-year-old woman was admitted to the Mater hospital, Newcastle, Australia after colonoscopy for review of her polyps. The patient was well until the next morning when she started to have severe abdominal pain and collapsed in the toilet. Her past medical history included: mastectomy for breast cancer, hysterectomy, open cholecystectomy, partial gastrectomy, hypertension, osteoporosis, pernious anaemia and hip replacement.Colonoscopy was performed under sedation with propofol monitored by staff anaesthetists. Colonoscopy was initially attempted in the left lateral position and subsequently in the supine position as difficulty was encountered while negotiating the colonoscope to the caecum because of looping. Two polyps found in the splenic flexure and transverse colon and were snared. The procedure was tolerated very well and the patient discharged home. Twelve hours later, the patient presented to emergency department with severe abdominal pain, abdominal distension and hypotension.