Iatrogenic Splenic Laceration Presenting as Syncope

Abstract

Millions of colonoscopies are performed annually for routine health maintenance in the United States. Patients commonly have adverse events from colonoscopy preparation, anesthesia, and procedural complications. We report a case of syncope secondary to iatrogenic splenic laceration from colonoscopy.

Iatrogenic Severe Splenic Injury after Colonoscopy

“…Splenic injury is a rare complication of colonoscopy [ 1 – 3 , 5 – 10 ]. The symptoms associated with postcolonoscopy splenic injury are nonspecific, and there is significant variability in the timing of onset of symptoms [ 1 ]; hence, it poses a diagnostic dilemma for clinicians [ 4 ]. Most often, it is diagnosed after it appears on the CT abdomen performed to rule out differentials including colonic perforation or retained gas following colonoscopy [ 5 , 6 , 11 ].…”

“…In some cases, patients may be completely asymptomatic [ 6 , 7 ]. Clinical signs of hypotension, anemia, and elevated white blood cell count may be present [ 2 , 4 , 6 ].…”

“…Maneuvers such as the endoscope slide by advancement, alpha maneuver, hooking of the splenic flexure, and straightening of the sigmoid loop may lead to avulsion of the splenocolic ligament resulting in laceration or rupture of the spleen [ 3 , 4 , 10 – 12 , 15 ]. Furthermore, adhesions between the colon and the spleen from previous abdominal surgeries, inflammation, or infections have been suggested to increase traction from decreased mobility of the spleen and colon leading to splenic injury [ 4 , 7 , 8 ]. Precautionary measures such as placing patients in the left lateral position are recommended and are associated with a decreased occurrence in injuries to the spleen [ 1 – 6 , 13 ].…”

“…Unfortunately, up to 77.4% of patients presenting with splenic injury after colonoscopy may need surgical exploration with as high as 95% of patients needing splenectomy [ 8 , 12 ]. More recently, the use of proximal splenic artery embolization (PSAE) in patients managed conservatively has been suggested to reduce the need for salvage surgical intervention [ 8 ] due to the high failure rates in nonoperative, conservative management compared to patients with injuries from blunt external trauma [ 4 , 8 ]. There is however no sufficient data to suggest better outcomes and to advocate its use preemptively, as the standard of care in hemodynamically stable patients with grade III or less who are managed conservatively.…”

“…Splenic injury is also a complication of colonoscopy, with only about 100 reported cases worldwide, making it a rare complication of colonoscopy [ 1 , 2 ]. Here, we present a patient who developed significant splenic injury (grade III) [ 4 ] with hemoperitoneum as a complication of diagnostic colonoscopy. This case report highlights the importance of a high index of suspicion in patients with vague abdominal symptoms after colonoscopy and the need to increase awareness for splenic injury as a possible complication of colonoscopy, especially among family physicians, emergency room providers, and internists.…”