Laparascopic Splenectomy Due to Splenic Injury after Colonoscopy

Abstract

Colonoscopy, which is routinely performed in diagnosis and treatment of colorectal disorders, is a reliable procedure. Its most frequent complications are bleeding and perforation. Splenic rupture is a very rarely met complication of colonoscopy, and delay in its diagnosis leads to increased morbidity and mortality. We presented a 69 years old female patient, who was diagnosed by computerized abdominal tomography, performed for her abdominal pain, which started following the colonoscopy. After 15 days of medical treatment and follow-up, laparoscopic splenectomy was performed one month after her colonoscopy. The patient was discharged on her 4 th postoperative day, with uneventful recovery. In patients who have complaint of abdominal pain following colonoscopy, an intraabdominal pathological condition should be considered and computerized abdominal tomography should be performed. If there is no detected intraperitoneal bleeding, in other words, if there is a sub-capsular hematoma of the spleen, medical management by monitoring the vital signs may be preferred. Then, splenectomy should be performed at an appropriate time. Keywords: Laparoscopy, splenectomy, colonoscopy ÖzKolonoskopi kolorektal hastalıkların tanı ve tedavisinde rutin olarak yapılan güvenilir bir işlemdir. En sık görülen komplikasyonlar kanama ve perforasyondur. Dalak rüptürü ise oldukça nadir görülen bir durumdur. Tanıda gecikme morbidite ve mortalitiye artırır. Biz 69 yaşında bir bayan hastayı sunduk. Kolonoskopi sonrası başlayan karın ağrısı şikayeti olan hastaya çekilen batın tomografisi ile tanı konuldu. On beş gün süreyle medikal tedavi uygulanan ve takip edilen hastaya kolonoskopiden 1 ay sonra laparaskopik splenektomi yapıldı. Ameliyat sonrası bir patoloji olmayan hasta 4. gün taburcu edildi. Kolonoskopi sonrası karın ağrısı oluşan hastalarda batın içi bir patoloji olabileceği düşü-nülerek batın tomografisi yapılmalı. Eğer periton içi bir kanama yoksa yani dalakta subkapsüler bir hematom var ise vital bulgu takibi ile medikal tedavi yapılabilir. Daha sonra hastaya uygun zamanda splenektomi yapılmalıdır.

Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

“…138 publications (7 case series and 131 singular case reports) were included of 163 individual patients treated primarily with splenectomy for splenic laceration after colonoscopy 11,14,15,17–19,31,33,34,40,42,45,50,52–176 . Individual patient data are shown in Supplementary Table and presented in comparison to SAE and splenorrhaphy in Table 1.…”

“…A minority (37%) of colonoscopies were interventional (Supplementary Table S2 ). Only three splenectomies were performed laparoscopically, 139 , 148 , 160 with the majority (98%) via laparotomy. All‐cause mortality was 5.5% ( n = 9), with most succumbing to shock and multi‐organ failure.…”

Splenic Injury After a Colonoscopy: Threading the Scope Carefully in Heritable Connective Tissue Disorders

“…Authors suggest prompt surgical evaluation in patients with recent colonoscopy and hemodynamic compromise [ 3 , 15 ]. Urgent laparotomy with splenectomy is recommended when there is active bleeding, hemodynamic instability, or hemoperitoneum, while a laparoscopic approach can be first-line in stable patients [ 5 , 13 , 16 ]. High-risk patients can be offered coil embolization of the splenic artery [ 17 ].…”

Grade III Spleen Laceration After a Colonoscopy Treated with Splenic Artery Embolization: A Case Report

“…The reported complications rate averages 0.4%, which most commonly includes bleeding, perforation, and, rarely, splenic rupture [ 2 ]. There are just over 100 reported cases of splenic injury following colonoscopy in the literature, and it was first reported by Wherry et al in 1974 [ 3 ]. The diagnosis is confirmed by a computed tomography (CT) scan of the abdomen and pelvis.…”