Is non-operative management feasible for splenic injury due to colonoscopy?

Abstract

Colonoscopy is a widely used diagnostic and therapeutic procedure. While it is a relatively safe procedure, there is a risk of some complications. Splenic injury after colonoscopy is a very rare but a life-threatening complication; around 105 cases have been reported in the literature so far. Owing to the rarity of this complication, no management standards were defined. In the literature, most of the patients were managed with operative intervention and less frequently with observation. We report a case of splenic injury and massive hemoperitoneum due to colonoscopy treated non-operatively.

The unusual case of the irretrievable colonoscope

“…Another potential problem was the potential risk of splenic injury. There are documented cases of splenic injury caused by difficulties in intubation, looping or traction on the either splenocolic ligament or adhesions to this ligament . An overaggressive attempt to retrieve the colonoscope in this case could quite easily have caused significant injury to the patient's spleen.…”

Splenic injury following Colonoscopy

“…Intra-abdominal bleeding causes persistent hemodynamic instability which mandates fluid resuscitation and operative intervention. The incidence of splenic injury during colonoscopy will probably high in the upcoming years due to the widespread use of the procedure [2].…”

“…Evidence shows, splenectomy is the treatment of choice for haemodynamically unstable patients and it is the most used option in 56.1% [1,5] followed by conservative treatment in 27.3% [1] and embolization in 4.5% [1]. Conservative treatment with close monitoring is an option for haemodynamically stable patients [2].…”

Laparascopic Splenectomy Due to Splenic Injury after Colonoscopy

“…The symptoms of patients admitted after more than 24 hours following colonoscopy are milder, related to injuries (5,9). The most frequent symptom is left upper quadrant pain with a rate of 93%.…”

“…Its incidence is 1-21/100,000 and the first case was reported in 1974 [3,4]. In the literature, the number of cases reported until now is just over 100 [5]. Although complaints develop within a few hours following colonoscopy in most of the patients, delay in diagnosis is quite common and this situation leads to increased morbidity and mortality [4,6].…”