Iatrogenic splenic injury: review of the literature and medico-legal issues

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_med-2016-0059_s_401_w2aab3b8d387b1b7b1aab1c14b1Aa"><jats:title>Introduction</jats:title><jats:p>Iatrogenic splenic injury is a recognized complication in abdominal surgery. The aim of this paper is to understand the medico-legal issues of iatrogenic splenic injuries. We performed a literature review on PubMed and Scopus using iatrogenic splenic or spleen injury and iatrogenic splenic rupture as keywords. Iatrogenic splenic injury cases were identified. Most cases were related to colonoscopy, but we also identified cases related to upper gastrointestinal procedures, colonic surgery, ERCP, left nephrectomy and/or adrenalectomy, percutaneous nephrolithotomy, vascular operations involving the abdominal aorta, gynecological operation, left lung biopsy, chest drain, very rarely spinal surgery and even cardiopulmonary resuscitation. There are several surgical procedures that can lead to a splenic injury. However, from a medico-legal point of view, it is important to assess whether the cause can be attributed to a technical error of the operator rather than being an unpredictable and unpreventable complication. It is important for the medico-legal expert to have great knowledge on iatrogenic splenic injuries because it is important to evaluate every step of the first procedure performed, how a splenic injury is produced, and whether the correct treatment for the splenic injury was administered in a judgment.</jats:p></jats:sec>

Splenic Laceration: A Rare Complication of Abdominal Paracentesis

“…While injury to intra-abdominal organs is a known complication of paracentesis, splenic laceration has not been described as an observed complication in the literature. Splenic laceration is a rare but observed complication of a wide range of invasive abdominal and thoracic procedures [ 3 ]. The procedure most commonly associated with such injury is a colonoscopy, with upper gastrointestinal endoscopy also known to cause splenic injury [ 3 ].…”

“…Splenic laceration is a rare but observed complication of a wide range of invasive abdominal and thoracic procedures [ 3 ]. The procedure most commonly associated with such injury is a colonoscopy, with upper gastrointestinal endoscopy also known to cause splenic injury [ 3 ]. Renal and pleural biopsy, nephrectomy, and thoracentesis have also been associated with splenic complications [ 3 ].…”

A delayed presentation of splenic laceration and hemoperitoneum following an elective colonoscopy: A rare complication with uncertain risk factors

“…There have been lawsuits reported in Italy involving SI post-colonoscopy. 16 , 17 For both the patient’s understanding of the inherent risks of a minimally invasive procedure and medicolegal obligations, the endoscopist should make an effort to discuss this rare but potentially fatal complication with his or her patient.…”

Splenectomy indications and postoperative follow-up results of a department of general surgery

“…The most common splenectomy indications are splenic injuries due to iatrogenic or external trauma nowadays (21,22,(24)(25)(26). The most common indication for elective splenectomy is ITP (26).…”