Shock due to Splenic Injury after Colonoscopy

Nallayici, Erol G.; Groot, Reinier de; Zanten, R. A. A. Van; Holzik, M F Lutke

doi:10.1159/000455940

Cited by 9 publications

(5 citation statements)

References 9 publications

(25 reference statements)

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Lukies,

Clements

2023

UEG Journal

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BackgroundSplenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low‐grade injuries or with splenectomy for high‐grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes of published cases of splenic injury due to colonoscopy treated with splenic artery embolisation.MethodsA systematic review was performed of published articles concerning splenic injury during colonoscopy treated primarily with splenic artery embolisation, splenectomy, or splenorrhaphy from 1977 to 2022. Datapoints included demographics, past surgical history, indication for colonoscopy, delay to diagnosis, treatment, grade of injury, splenic artery embolisation location, splenic preservation (salvage), and mortality.ResultsThe 30 patients treated with splenic artery embolisation were of mean age 65 (SD 9) years and 67% female, with 83% avoiding splenectomy and 6.7% mortality. Splenic artery embolisation was proximal to the splenic hilum in 81%. The 163 patients treated with splenectomy were of mean age 65 (SD 11) years and 66% female, with 5.5% mortality. Three patients treated with splenorrhaphy of median age 60 (range 59–70) years all avoided splenectomy with no mortality. There was no difference in mortality between splenic artery embolisation and splenectomy cohorts (p = 0.81).ConclusionsSplenic artery embolisation is an effective treatment option in splenic injury due to colonoscopy. Given the known benefits of splenic salvage compared to splenectomy, including preserved immune function against encapsulated organisms, low cost, and shorter hospital length of stay, embolisation should be incorporated into treatment pathways for splenic injury due to colonoscopy in suitable patients.

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Section: Resultsmentioning

confidence: 99%

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

Lukies,

Clements

2023

UEG Journal

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“…It is also generally described as diffuse and generalised pain in about 1/3 of the cases. Other symptoms include left shoulder pain (40%), dizziness (10%) and syncope (8%) 9 18. With non-specific clinical manifestations, patients are often misdiagnosed with the discomfort after the procedure due to distension of the intestine and bloating from the inflated air during the procedure 15…”

Section: Discussionmentioning

confidence: 99%

Splenic rupture as a rare and unpredicted complication in a patient with systemic lupus erythematosus after colonoscopy

Thavaraputta¹,

Laoveeravat

Thavaraputta

et al. 2019

BMJ Case Rep

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Colonoscopy is a common procedure that gastroenterologists perform on a daily basis. It is considered a low-risk outpatient procedure and patients can be discharged on the same day after the procedure. Colonoscopy has become more feasible with the increasing application of standard screening for colon cancer and diagnostic procedures for large intestinal disease. There are reported possible risk factors of splenic rupture during the procedure. However, splenic injury after colonoscopy is considered a rare complication and less than 100 cases have been reported in international literature. Interestingly, this is the first case report demonstrating systemic lupus erythematosus (SLE) as a possible risk factor leading to splenic rupture post-colonoscopy. Failure to recognise this possibility even in its rarity can lead to life-threatening complications. We present a case of an acute splenic rupture with massive intraperitoneal bleeding after colonoscopy in a patient with SLE.

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“…Also, defecation might cause rising of intra-abdominal pressure that could induce a rupture of the hematoma. There have also been a few reports of splenic rupture as a complication of colonoscopy [ 11 ]. One of the reported mechanisms underlying such complications is stretching of the splenocolic ligament during colonoscopy, which can lead to avulsion or tearing of the spleen.…”

Section: Discussionmentioning

confidence: 99%

A rare mechanism of delayed splenic rupture following the nonoperative management of blunt splenic injury in a child

et al. 2018

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BackgroundNonoperative management (NOM) has been established as the standard treatment for isolated blunt organ injury in hemodynamically stable pediatric patients. Although delayed splenic rupture or bleeding is a rare complication in NOM, it is an issue that many pediatric surgeons are greatly concerned about. We herein report a rare pediatric case concerning the mechanisms involved in delayed splenic rupture after NOM.Case presentationA 9-year-old boy with severe abdominal pain was transferred to our hospital. Twenty-one hours before the admission, he had been kicked in the region of his left lateral abdomen. Contrast-enhanced abdominal computed tomography revealed a severe intra-parenchymal hematoma and multiple lacerations of the spleen with a large amount of hemoperitoneum without active bleeding. His condition was diagnosed as a grade III injury on the AAST splenic injury scale. After fluid resuscitation, his vital signs became stable. The patient was treated with NOM in our intensive care unit. However, suddenly after defecation (72 h after the injury), he started complaining of severe abdominal pain and left shoulder pain. His blood pressure dropped to 70/35 mmHg, and he started to lose consciousness. Abdominal ultrasonography (US) revealed increased ascites. Fluid resuscitation and blood transfusion were performed. His symptoms and abdominal US findings suggested that splenic re-bleeding had caused delayed splenic rupture to occur. Emergency splenectomy was performed. The resected spleen was enlarged with a large parenchymal hematoma. The posterior-lateral side of the splenic capsule was ruptured.ConclusionsThe mechanism of delayed splenic rupture in our case was considered to be the result of a tear in the subcapsular hematoma caused by stretching the splenocolic ligament related to a bowel movement during defecation. Although delayed splenic rupture or bleeding is unpredictable, it is very important to understand the mechanisms and to educate the family of the children with splenic injuries of the warning signs of delayed rupture or bleeding.

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Shock due to Splenic Injury after Colonoscopy

Cited by 9 publications

References 9 publications

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

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

Splenic rupture as a rare and unpredicted complication in a patient with systemic lupus erythematosus after colonoscopy

A rare mechanism of delayed splenic rupture following the nonoperative management of blunt splenic injury in a child

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