Splenic rupture as an endoscopic complication: as rare as it appears?

Alcázar, M.M. Díaz; Robles, Adelina García; Maldonado, Alicia Martín Lagos

doi:10.17235/reed.2020.7342/2020

Cited by 5 publications

(6 citation statements)

References 5 publications

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“…This complication has been described as very rare, with an incidence of 0.004 % (4). Interestingly the cases presented here and before (1,4) suggest that the incidence of this complication could be higher.…”

Section: Discussionmentioning

confidence: 62%

“…Our case presented tobacco consumption, oncological history and polypectomy (1,2) as risk factors for splenic injury after colonoscopy. Due to pedunculated polyp morphology wall damage was minimal.…”

Section: Discussionmentioning

confidence: 79%

“…Hemoperitoneum due to splenic injury after colonoscopy, a complication perhaps not so uncommon Guillermo Castillo-López 1 , Daniel Rodríguez-Alcalde 1 , Javier Páramo Zunzunegui 2 Departments of Gastroenterology 1…”

mentioning

confidence: 99%

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Hemoperitoneum due to splenic injury after colonoscopy, a complication perhaps not so uncommon

2021

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 79%

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Hemoperitoneum due to splenic injury after colonoscopy, a complication perhaps not so uncommon

2021

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“…Of note, as reflected in our study, splenic rupture may develop following an episode of infarction. Several reported cases described the association between anticoagulant therapy and subsequent splenic rupture (21)(22)(23)(24). While ultrasound appears to have a low diagnostic yield for SI, it is useful in the detection of complications following SI, such as splenic rupture with hemoperitoneum (25,26).…”

Section: Discussionmentioning

confidence: 99%

Anticoagulant Therapy Is Associated With Decreased Long-Term Mortality in Splenic Infarction Patients: A Multicenter Study

et al. 2021

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Background: Patients with splenic infarction (SI) are associated with a prothrombotic state and are vulnerable to subsequent thromboembolic complications. However, due to its rarity, there is no established treatment modality in this population. We aimed to examine the effect of anticoagulant therapy in SI patients.Methods: We performed a multicenter retrospective cohort study of 86 SI patients. Patients were categorized as anticoagulant users and anticoagulant non-users. The associations between anticoagulant therapy, all-cause mortality, thromboembolic events and bleeding events were evaluated.Results: Forty-five patients (52.3%) received anticoagulant therapy during the follow-up periods. The all-cause mortality rate was 6.86 per 100 patient-years. Anticoagulant therapy was associated with 94% improved survival (HR = 0.06; Cl 0.007–0.48; p = 0.008), while the risk factors for all-cause mortality were prior stroke (HR = 13.15; Cl 2.39–72.27; p = 0.003) and liver cirrhosis (HR = 8.71; Cl 1.29–59.01; p = 0.027). Patients with anticoagulant therapy had a higher event-free survival curve for thromboembolic complications (p = 0.03) but did not achieve a significant difference after adjustment using the Cox regression model as a time-dependent covariate (HR = 0.57; Cl 0.13–2.45; p = 0.446). There was no significant difference in the risk of bleeding events between the groups (p = 0.728).Conclusions: Anticoagulant therapy in patients with SI was associated with better survival and was not related to an increased bleeding risk.

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“…Amongst known complications, splenic injuries occur at a rate of 0.20 per 10,000 colonoscopies, carrying a high mortality rate [ 4 , 5 ]. As the volume of colonoscopies rises, splenic injuries are being reported increasingly more frequently, and risk factors such as age, female sex, splenomegaly, adhesions from prior surgeries, malignancy, sepsis, polypectomy, or ongoing anticoagulation have been parsed out [ 3 , 6 , 7 ]. The risk for mortality is most significant in the acute inpatient setting, and lack of early identification of splenic injuries can prolong hospital stay and reduce the quality of life [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Splenic Injury After a Colonoscopy: Threading the Scope Carefully in Heritable Connective Tissue Disorders

Wiggins¹,

LaMarche²,

Gupta³

et al. 2021

Cureus

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Colonoscopies have reduced colorectal cancer (CRC) burden in the United States, and their utility has expanded to include various diagnostic and therapeutic indications. Complications are seen in up to 1% and increase with age and polypectomy. As colonoscopies become widespread, specific populations seem to be at a much higher risk; notably patients with heritable connective tissue disorders (HCTD). As life expectancy increases, these patients undergo routine screenings and require careful peri-endoscopic care to reduce adverse outcomes. Amongst HCTD, Ehlers-Danlos syndrome (EDS) is commonly implicated, however, no reports of Marfan syndrome (MS) exist. We present a unique case of splenic injury after colonoscopy in a patient with MS. Successful outcomes require early suspicion and emergent surgical evaluation in patients with hemodynamic instability after a colonoscopy. Increased ligament laxity and bowel fragility are the most likely mechanisms. Alternative CRC strategies like fecal immunochemical test (FIT), fecal occult, Cologuard, or virtual colonography can be considered.

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Splenic rupture as an endoscopic complication: as rare as it appears?

Cited by 5 publications

References 5 publications

Hemoperitoneum due to splenic injury after colonoscopy, a complication perhaps not so uncommon

Hemoperitoneum due to splenic injury after colonoscopy, a complication perhaps not so uncommon

Anticoagulant Therapy Is Associated With Decreased Long-Term Mortality in Splenic Infarction Patients: A Multicenter Study

Splenic Injury After a Colonoscopy: Threading the Scope Carefully in Heritable Connective Tissue Disorders

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