Post Colonoscopy Splenic Injuries: Case Series and Recommendations

Abstract

Splenic injury is an uncommon, but serious complication of colonoscopy. Any cause of excessive spleno-colic adhesions, splenomegaly, or underlying splenic disease would be a predisposing factor for splenic injury during colonoscopy. A delay in diagnosis has been noted as many physicians are not aware of this complication of colonoscopy. We report two cases of splenic injury secondary to screening colonoscopy. The first refers to a 61-year-old male, who was involved in a motor vehicle accident a month prior to the procedure; with the second case that of a 46-year-old healthy female. Clinical, biochemical and radiological findings were suggestive of a splenic rupture and hemoperitoneum. Both patients had grade III splenic ruptures with hemodynamic instability, which warranted urgent splenectomy. Both patients had an uneventful recovery. Proposed mechanisms are traction on the spleno-colic ligament leading to splenic capsule avulsion or direct splenic trauma due to colonoscopic manipulation. So-called “ looping of the colonoscope ” in the bowel, followed by aggressive straightening can cause strain on the spleno-colic ligament and tearing of blood vessels. The presence of Kehr ’ s sign in an hemodynamically unstable patient is a very sensitive pointer towards splenic rupture. Patients with recent abdominal trauma should be properly screened with appropriate history and investigations prior to colonoscopy. CT scan of the abdomen is the test of choice for the evaluation of splenic injury. Splenectomy is the most commonly performed procedure for post-colonoscopy injuries of the spleen. doi: http://dx.doi.org/10.4021/jmc1498w