Left Shoulder Pain After Routine Colonoscopy: An Unusual Presentation of Splenic Laceration

Abstract

Splenic injury is an uncommon complication following a colonoscopy procedure. Splenic laceration typically presents with post-procedural abdominal pain. We present a case of nonspecific shoulder pain, following an uneventful routine colonoscopy and highlight the importance of maintaining a high degree of clinical suspicion for the general gastroenterologist.

Splenic Injury After a Screening Colonoscopy

“…Splenic injury after a colonoscopy is an infrequent complication with an estimated incidence of 1 in 100000 patients (0.001%) [3]. Since the first reported case of splenic injury after a colonoscopy by Wherry DC and Zehner H in 1974 [5], 73 more cases have been reported in the literature [2,3,[6][7][8][9]. The mechanism behind splenic injury after a colonoscopy is poorly understood.…”

“…Other less common presentations included dizziness, syncope, and back or chest pain [2,3,[5][6][7]. One case reported left shoulder pain as the initial presentation two hours after a screening colonoscopy [8]. While most patients develop symptoms within 24 hours of colonoscopy, it can take up to 72 hours to develop symptoms after the procedure [2,5].…”

“…A total of 39% (n=29/74) of the patients, including ours, were managed conservatively with close monitoring and serial examinations, IV fluids, blood transfusions, and analgesics. Angioembolization by interventional radiology should also be considered in hemodynamically stable patients with active contrast extravasation on imaging [ 2 , 3 , 5 - 8 ]. The overall mortality rate from splenic injury after a colonoscopy is reported at around 10%.…”

“…However, splenic injury after colonoscopy is a rare but potentially life-threatening complication. First reported in 1974, and its incidence has increased since then, with 73 cases reported so far [ 1 - 8 ]. Here, we describe a case of subcapsular splenic hematoma after a screening colonoscopy.…”