Splenic Rupture After Colonoscopy

Kiosoglous, Anthony J.; Varghese, Rosemol; Memon, Muhammed Ashraf

doi:10.1097/sle.0b013e3181a1439a

Cited by 13 publications

(6 citation statements)

References 7 publications

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“…An array of types of splenic injuries arising from colonoscopy have been noted in case reports, including splenic/perisplenic/subscapsular haematoma, rupture, laceration, capsular tear and capsular avulsion 18–23. Severity of the splenic injury can be stratified with the American Association for the Surgery of Trauma splenic injury grading scale 2.…”

Section: Discussionmentioning

confidence: 99%

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

Chow

Zia

2019

BMJ Case Rep

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Splenic rupture secondary to colonoscopy is a rare but potentially fatal complication. Given the disparity between the small number of case reports with the incidence reported by some investigators, we contend that the former is not representative of the true extent of this sequela. We present a case report of postcolonoscopy splenic rupture, where the patient had a bizarre initial presentation of chest pain and collapse; and only developed haemodynamic instability and abdominal pain on day 2 postprocedure. Diagnosis was made with a CT scan, and resolution of symptoms was achieved with a splenectomy.

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Section: Discussionmentioning

confidence: 99%

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

Chow

Zia

2019

BMJ Case Rep

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“…Pain may also be felt in the left shoulder or left chest [4, 5, 7, 9–13, 15]. Abdominal examination generally reveals abdominal distention [1, 2, 8, 11, 13]. Vital signs and laboratory tests often indicate hypotension and/or anemia, although some patients may not have these on initial presentation [1, 2, 4, 6–13, 15].…”

Section: Discussionmentioning

confidence: 99%

“…However, US is the best for identifying the presence of free fluid in the peritoneum and further imaging, such as a CT, is better for delineation of the extent of injury to the spleen [2, 14]. In patients that are hemodynamically stable, this test is the gold standard for the evaluation and assessment of splenic injury [1, 2, 4, 6, 8, 9, 11, 15]. …”

Section: Discussionmentioning

confidence: 99%

“…Patients that are hemodynamically stable can be managed successfully with conservative treatment consisting of observation, IV fluids, and blood transfusions as needed [5, 13]. However, a number of such cases will need surgical intervention [4, 7, 9, 11]. Another option, utilized in our case, is splenic artery embolization.…”

Section: Discussionmentioning

confidence: 99%

“…Most agree that direct trauma to and/or increased traction on the spleen and/or the splenocolic ligament is a likely mechanism [1–4, 6–8, 10–15]. Risk factors for splenic laceration following a colonoscopy may include application of external pressure during the procedure, adhesions between the spleen and colon, [8, 11] and polypectomy and/or biopsy during the procedure [1–3, 6, 8, 9, 12]. Yet none of these factors was found to be common among any of the patients in the various reports.…”

Section: Discussionmentioning

confidence: 99%

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Acute Colonoscopy-Induced Splenic Rupture Presenting to the Emergency Department

Chow

Shih

2013

Case Reports in Emergency Medicine

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Splenic rupture due to colonoscopy is a rarely reported event in the emergency medicine literature. Patients experiencing such an occurrence are likely to report to the emergency department. This paper documents an 84-year-old female who presented to the emergency department with abdominal pain and nausea less than 24 hours following a colonoscopy. An abdominal ultrasound revealed splenomegaly and free fluid. An abdominal computed tomography was significant for a splenic laceration. She underwent radiologic guided embolization and recovered without incident. Emergency medicine physicians need to consider splenic rupture as a differential in patients presenting after colonoscopy with abdominal pain.

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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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Splenic Rupture After Colonoscopy

Cited by 13 publications

References 7 publications

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

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

Acute Colonoscopy-Induced Splenic Rupture Presenting to the Emergency Department

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

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