Splenic Injury as a Complication of Endoscopy: Two Case Reports and a Literature Review

Abstract

Two cases of splenic injury - one after a difficult colonoscopy and the other after routine ERCP - are reported. Splenic injury as a complication of endoscopic procedures is relatively rare, but over the past several years this complication has been increasingly reported. Review of the literature revealed 11 cases occurring after colonoscopy and one after ERCP. Although most of the patients presented with acute abdominal symptoms, some had mild vague symptoms. In two cases the injury was overlooked entirely. Diagnosis was established at laparotomy in four cases, by CT in four, by ultrasonography in two, by chance observation in two, by angiography in one and by paracentesis in one. All patients except the most recent three reported underwent surgery, with one mortality occurring three weeks after the operation.

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“…The first case of post-ERCP splenic injury was reported in 1988, 2 and since then, 11 cases of ERCP-related splenic injury have been reported. [3][4][5][6][7][8][9][10][11][12][13] This is the first case of ERCP-related splenic injury reported postorthotopic liver transplant. The intraoperative findings are varied, with cases of splenic laceration or rupture, 2,4-7,11-13 and avulsion of the splenic vessels, 8 splenic capsule avulsion as a result of intraabdominal adhesions and adherence of the splenic capsule to the anterior abdominal wall, 9 splenic injury complicated by a subcapsular splenic abscess, 10 and avulsion of the short gastric vessels.…”

Splenic Rupture after Colonoscopy

“…The first case was reported in 1974 (10) and the number of cases with splenic rupture due to colonoscopy reported is 102, since then (6). Smith et al and Ong et al each reported one case of splenic injury in a series of 20139 and 6387 colonoscopies, respectively (11,12). However, the number of cases with splenic rupture due to colonoscopy reported to be 102 cases (6).…”

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

“…Smith et al 13 (overall complication rate 0.4% for diagnostic colonoscopy, 1.8% for colonoscopy with polypectomy), reported only one incident case of splenic injury in a series of 20,139 surgeon-performed colonoscopies. Ong et al 18 similarly reported one case of splenic injury in 6387 colonoscopies, whereas Jentschura et al 19 reported (overall complication rate of 0.4%; 0.83% after polypectomy) no splenic injuries in 29,695 cases. Therefore, serious complications following colonoscopy are rare, but the true incidence of splenic injury following colonoscopy remains unknown.…”