Splenic injury after colonoscopy requiring splenectomy

Abstract

We present a case of a middle-aged woman, who presented with abdominal pain less than 24 h following an uneventful colonoscopy for rectal bleeding. Initial diagnosis was thought to be colonic perforation. An urgent CT scan performed owing to dropping haemoglobin and blood pressure revealed a large perisplenic haematoma. An urgent laparotomy was performed in which the patient had a total blood loss of 2500 ml and required splenectomy. The patient recovered well postoperatively.Colonoscopy is a commonly performed procedure in which complications of perforation and bleeding are well recognised. This case represents one of the rare but serious complications that endoscopists and patients should be aware of to aid prevention and early diagnosis.

Postcolonoscopy splenic rupture: the under-reporting of an unpropitious phenomena?

“…In the same vein, the annual incidence of this sequela is estimated at 2300 significant splenic tears per annum in the USA 7. This disparity between the reported cases and the incident rate may be attributed to a lack of enthusiasm among endoscopists in reporting their morbidity, poor recognition of this complication, and a possible publication bias 5 10. Given the gravity of this complication, greater awareness to this matter is warranted.…”

Peri-colonic haematoma following routine colonoscopy

“…Extra-colonic bleeding following colonoscopy is rare. Causes that have been identified in the literature include splenic injury, mesenteric tears, hepatic injury and retroperitoneal haemorrhage [5] , [8] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] . To the authors' knowledge, there is very little published literature specifically on isolated peri-colonic haematomas following colonoscopy.…”

“…Splenic injury is the most commonly reported causes of extra colonic bleeding post colonoscopy with over 100 cases reported and an overall estimated incidence of 0.00005–0.017% [2] , [5] , [7] , [8] , [9] , [10] , [16] , [17] , [18] , [19] . Abdominal pain with haemodynamic instability is the commonest method of presentation and usually occurs within 48 h. CT scan provides the most sensitive and specific method of diagnosis [16] .…”

“…A normal erect chest x ray image should not prevent further imaging with CT if there is any clinical suspicion of an intra-abdominal complication. CT scanning, should be the investigation of choice in these circumstances [16] , [17] . In cases of extra colonic bleeding CT scanning will facilitate the diagnosis, identify active haemorrhage and assist in determining whether conservative management is appropriate.…”

“…Once a diagnosis of extra-colonic haematoma has been established, conservative management with intravenous fluids and blood transfusions may be sufficient [16] , [17] . In such patients there should be a period of close observation and follow up to ensure the condition is resolving.…”