Splenic injury as a complication of colonoscopy and polypectomy

Doctor, Naishad M.; Monteleone, Frank; Zarmakoupis, Constantino; Khalife, Michael

doi:10.1007/bf02554287

Cited by 29 publications

(16 citation statements)

References 14 publications

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“…19,23 Although not required for rupture, a higher incidence of splenic rupture is reported in cases where polypectomy, biopsy, or technical difficulties are present. 7,14,20,23 Of 27 reported cases where appropriate information could be identified, 11 patients had polypectomy or biopsy performed and 11 had a history of a previous surgical procedure (Table 1).…”

Section: Discussionmentioning

confidence: 98%

Splenic Rupture After Colonoscopy: Case Report and Literature Review

Tsoraides¹,

Gupta²,

Estes³

2007

The Journal of Trauma: Injury, Infection, and Critical Care

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C olonoscopy has become an invaluable tool in the diagnosis and treatment of diseases of the colon and rectum. The most common complications are bleeding and perforation, which occur in up to one percent of patients undergoing diagnostic colonoscopy and three percent of patients undergoing therapeutic colonoscopy. 1 Less common complications include pneumothorax, pneumomediastinum, mesenteric tear and colonic volvulus. Splenic rupture is a rare colonoscopic complication, with only 24 cases reported in American literature 2-23 and 11 additional cases reported in foreign literature. 24 -34 The first case of splenic rupture resulting from colonoscopy was reported in 1974 by Wherry and Zhener. 2 We present our experience with a case of splenic rupture after colonoscopy in a 59-year-old woman managed without surgical intervention. CASE REPORTA 59-year-old white woman with a family history of colon cancer underwent a screening colonoscopy. Her surgical history included a total abdominal hysterectomy and a subsequent salpingo-oophorectomy. The colonoscopy was performed without difficulty. Diagnostic findings were a tortuous left colon, hemorrhoids and rare diverticuli. No polyps or cancer were seen. The post-sedation recovery was uneventful and the patient felt well with no complaints upon routine discharge.Five hours after discharge the patient developed severe left-sided abdominal pain that radiated to the tip of her left shoulder. At assessment in the emergency room her heart rate was 97 bpm and blood pressure 141/79 mm Hg. Bowel sounds were normal, abdomen soft and non-distended with generalized tenderness. Abdominal films revealed gas within a non-distended colon, but no free air present. The patient was resuscitated with IV fluids and admitted to the intensive care unit by the medicine serivce. The hemoglobin level decreased from 12.0 g/DL to 6.6g/DL at 20 hours after admission. A resultant progressive tachycardia and low systolic blood pressure accompanied the decreasing hemoglobin level resulting in surgical consultation. Computed tomography (CT) revealed a Grade II-III splenic injury with no active extravasation (Fig. 1). A 14.4 ϫ 9.6 cm splenic hematoma extended down the left pericolic gutter into the pelvis and the liver was surrounded with a moderate amount of low density fluid consistent with free blood.Four units of packed red blood cells were administered and within the first 24 hours vital signs normalized and serial hemoglobin tests showed no evidence of active bleeding. Because there was no active bleeding or free air, and the splenic injury was Grade II-III, non-operative management was continued. By 27 hours after admission, the hemoglobin stabilized at 12.1 g/DL and did not significantly decline for the remainder of her hospitalization. Partial resolution of the hemoperitoneum and subcapsular splenic hematoma were seen on a follow-up CT scan on the 9th day (Fig. 2). The patient continued to improve clinically and was discharged home on the 10th day.

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Section: Discussionmentioning

confidence: 98%

Splenic Rupture After Colonoscopy: Case Report and Literature Review

Tsoraides¹,

Gupta²,

Estes³

2007

The Journal of Trauma: Injury, Infection, and Critical Care

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“…Twelve of 44 (27%) were splenectomized prophylactically in the absence of hemodynamic compromise (Table 4) [11,16,20,23,24,26,30,32,36,38,46,59], and in four operated patients the hemodynamic status was uncertain based on our review [4,6,10,74]. One case was splenectomized for the treatment of recurrent hemorrhagic splenic cyst after percutaneous drainage [6].…”

Section: Treatmentmentioning

confidence: 99%

“…Two patients presented for evaluation as late as 4 days after colonoscopy [29,54]. One patient remained asymptomatic, and the splenic injury was discovered the day following colonoscopy during a scheduled laparotomy to resect rectal cancer [30].…”

Section: Clinical Presentation Of Splenic Injurymentioning

confidence: 99%

Colonoscopy-induced Splenic Injury: Report of 3 Cases and Literature Review

Saad

Rex

2007

Dig Dis Sci

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Splenic injury during and after colonoscopy is more common in women. Technically difficult colonoscopy is a possible risk factor. Onset of symptoms is often delayed by hours. CT scan is probably the best diagnostic test for splenic injury after colonoscopy, though the literature indicated ultrasound is also sensitive. Patients with hemodynamic instability are most often operated. Patients with confined intrasplenic hematoma and hemodynamic stability can be given a trial of conservative management.

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“…One patient was completely asymptomatic. 6 Left shoulder tip pain (Kehr's sign) was present in 59.1% and over half (54.1%) remained cardiovascularly stable.…”

Section: Presentationmentioning

confidence: 99%

“…Some patients will suffer low-grade splenic injuries following colonoscopy, manifesting as mild and delayed 20 symptoms (one patient was asymptomatic 6 ). Thus, many splenic injuries may remain undiagnosed or be misdiagnosed as post-colonoscopy discomfort.…”

Section: Investigation Of Patients Presenting Post Colonoscopymentioning

confidence: 99%

Splenic injury following colonoscopy – an underdiagnosed, but soon to increase, phenomenon?

Skipworth

Rawal²,

Damink³

et al. 2009

Ann R Coll Surg Engl

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A 71-year-old woman presented to the emergency department, 6 days following a diagnostic colonoscopy (arranged following a routine-surveillance, positive, faecal occult blood test). She complained of lower abdominal pain and left-sided chest and shoulder pain, beginning on the first day following colonoscopy, associated with looking pale and feeling lethargic. Her general practitioner (GP) had prescribed oral antibiotics for a presumed lower respiratory tract infection.Her past medical history included atrial fibrillation, treated with sotalol and warfarin; a monitored abdominal aortic aneurysm (AAA); and treated hypothyroidism and hypercholesterolaemia. Her warfarin prescription had been ceased 5 days prior to colonoscopy (although her

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Splenic injury as a complication of colonoscopy and polypectomy

Cited by 29 publications

References 14 publications

Splenic Rupture After Colonoscopy: Case Report and Literature Review

Splenic Rupture After Colonoscopy: Case Report and Literature Review

Colonoscopy-induced Splenic Injury: Report of 3 Cases and Literature Review

Splenic injury following colonoscopy – an underdiagnosed, but soon to increase, phenomenon?

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