Splenic Rupture After Screening Colonoscopy: Case Report and Literature Review

Abstract

Splenic rupture is a rare complication after colonoscopy, and to date there are only 46 reported cases in the English-language literature. Presented is a case report of splenic rupture after screening colonoscopy that resulted in laparotomy and splenectomy within 24 hours of the original procedure. The article covers the hypothesized mechanisms of injury, various precautions to take during colonoscopy, suggested diagnostic algorithm, determining factors in treatment, and vaccine regimen. The article concludes by stating that as the number of colonoscopies increase, so will the prevalence of associated complications, and that physicians are encouraged to understand this paradigm shift.

Colonoscopy-Induced Splenic Injury: An Unusual Complication Warranting Urgent Attention

“…However, proposed risk factors can be divided into patientdependent risk factors and endoscopist-dependent risk factors (Table 1) [4,5,7,14,15,[17][18][19][20][21][22]. Patient-dependent factors include previous intra-abdominal surgery, anticoagulation, inflammatory bowel disease, pancreatitis, and splenomegaly.…”

“…Endoscopist-dependent predisposing factors include maneuvers that increase torque of the scope at the splenic flexure, such as hooking the splenic flexure to straighten the descending colon, slide by advancement, alpha maneuver, and intubation of the ileum [12,[17][18][19]23]. Other techniques that may cause splenic injury include polypectomy, biopsies, excessive looping, and applying external pressure to the left upper quadrant, which induces rupture through a direct blunt trauma or decreased mobility between the spleen and colon [14,[18][19][20][21]. Placing patients in supine position has also been identified as a risk factor by causing the spleen to fall posteriorly away from the splenic flexure, increasing traction on the spleen during colonoscopy.…”

“…Although technically difficult colonoscopies are proposed as a risk factor, the majority of splenic injuries reported have occurred in apparently uncomplicated colonoscopies without biopsies or polypectomies [4,13]. Even in cases that involved polypectomies, there was not a consistent site of polypectomy that led to an increased risk of splenic injury [19].…”

“…Contrast can also help grade the splenic injury according to the American Association of Surgeons for Trauma (AAST) Splenic Injury Grading Scale and helps identify active extravasation and other rare complications, such as hepatic injury or mesenteric hematomas [9]. Other less sensitive diagnostic studies include plain radiographs, ultrasound, peritoneal lavage, and laparotomy [13,19]. Plain radiographs can show raised left hemidiaphragm or leftsided pleural effusion, which may indicate splenic injury [15].…”

“…The three most common treatment options include splenectomy, splenic artery embolization, and medical management. The majority of patients undergo operative intervention with subsequent splenectomy [13,15,19]. Splenic artery embolization was first reported in 2002 and has been used in low to high grade splenic ruptures [13,19].…”