A systematic review of splenic injuries during colonoscopies: Evolving trends in presentation and management. Int J Surg. 2016;33 Pt A:55-59. [PMID: 27479605 DOI: 10.1016/j.ijsu.2016.07.067]

Splenic injury associated with colonoscopy in hospitalized patients: Incidence, risk factors, management, and outcome

Background and study aims The frequency of splenic injuries due to coloscopy is largely unknown. Therefore, the aim of this study was to give estimate the risk for hospitalized patients. Patients and methods Using the administrative database from a health insurance company with more than 10 million insured subjects, patients undergoing inpatient colonoscopy associated with a splenic injury within 2 weeks were retrieved from the administrative records based upon OPS (comparable to International Classification of Procedures in Medicine) and ICD-10 codes. In each case identified (n = 141), the individual course of the hospital stay was reconstructed and analyzed by two experienced physicians. Patients with overt other causes of splenic injuries (e. g. abominal surgery, trauma etc.) were not further evaluated. Results Among 190,927 total colonoscopies over a 5-year period, 27 splenic lesions were most likely solely due to colonoscopy. This accounts for 14.1 splenic injuries per 100,000 colonoscopies or one lesion in 7,071 patients. Afflicted patients were older and more likely to be female than male (risk in females: 1 in 5,324 colonoscopies). Surgical interventions were carried out in 17 cases, predominantly splenectomy (n = 15) whereas 10 events were managed conservatively. Transfusions and requirement for intensive care unit treatment were strong predictors of need for surgery. Most lesions (74%) were diagnosed within 48 hours after colonoscopy. Death occurred in two patients, but less likely directly due to the splenic injury. Conclusions Administrative data analysis suggests that splenic injuries due to colonoscopy are more frequent than previously estimated. Endoscopists should be aware of this rare life-threatening adverse event.

Post-colonoscopy splenic injury: A case report on diagnostic challenges and treatment strategies

INTRODUCTION AND IMPORTANCE

Colonoscopy, while generally safe, can rarely lead to severe complications such as splenic injury. This article reports a case of splenic injury post-colonoscopy, highlighting clinical challenges, diagnostic approaches, and treatment strategies. The goal is to raise awareness among healthcare professionals and enhance knowledge on managing such complications.

CASE PRESENTATION

A 60-year-old woman with chronic constipation underwent a challenging colonoscopy. Twelve hours later, she had acute abdominal pain, bloating, and anemia. Examination revealed tachycardia and a distended abdomen. Urgent CT showed splenic hematoma and hemoperitoneum. Initially managed conservatively with fluids and transfusions, she developed worsening tachycardia and persistent anemia, necessitating emergency laparotomy. Surgery confirmed significant hemoperitoneum and bleeding splenic lesion, leading to splenectomy. She stabilized and was discharged on the fifth postoperative day with antibiotics and vaccinations.

CLINICAL DISCUSSION

Splenic injury, though rare, is a serious complication of colonoscopy, occurring in 0.002 % to 0.033 % of cases. Symptoms include abdominal pain, left shoulder pain, dizziness, and syncope. Prompt diagnosis with contrast-enhanced CT, which identifies 98.5 % of injuries, is crucial. Treatment ranges from conservative management to emergency splenectomy, based on injury severity and patient stability. Non-operative management is often successful in stable patients, while splenectomy may be necessary for those with significant hemodynamic instability. Early recognition and appropriate treatment are essential for favorable outcomes.

CONCLUSION

Splenic injury is a rare but severe complication of colonoscopy. Early recognition and appropriate management are crucial for positive outcomes. Conservative treatment is often effective, but surgery may be needed for severe cases.

A case report of splenic injury related to colonoscopy: Fortunately treated with conservative treatment

Colonoscopy is a common procedure for screening of colon cancer. Although complications are rare, recently there have been reports of splenic injury associated with colonoscopy. Its causes are not clear. Herein, we report an 84-year-old man who underwent a colonoscopy for an annual routine examination. The colonoscopy was performed with moderate difficulty due to loop formation and took about 50 min. After the examination, he developed syncope, sweating, and abdominal distention with low blood pressure. Plain computed tomography revealed ascites, and the patient was hospitalized with close monitoring. The following day, his hemoglobin level was decreased by about 3.0 g/dL. Contrast-enhanced computed tomography revealed the splenic injury. The patient was hemodynamically stable and was treated conservatively. Splenic injury is an uncommon complication of colonoscopy; however, it may cause hemodynamic instability. Physicians performing colonoscopies should be aware of this potential complication.

Hemoperitoneum after routine colonoscopy: A case report

INTRODUCTION AND IMPORTANCE

Colonoscopy is a routine examination which is considered a safe and low risk procedure. Hemoperitoneum due to a splenic injury after colonoscopy is a rare but life-threatening complication.

CASE PRESENTATION

We present the case of a 57-year-old woman without medical or surgical history who presented acute abdominal pain after a colonoscopy with three polypectomies. Clinical, biological investigations and imaging were suggestive for a hemoperitoneum. An emergency exploratory laparoscopy revealed a massive hemoperitoneum due to 2 avulsions of the splenic capsule.

CLINICAL DISCUSSION

We review the literature on incidence, mechanisms, risk factors, common symptoms, diagnosis methods and therapeutic options concerning hemoperitoneum due to a splenic injury after colonoscopy.

CONCLUSION

The early suspicion of this potential complication is the key to good care in this situation.

Splenic Rupture Following Colonoscopy

Splenic rupture following colonoscopy (SRFC) is a rare complication and can have associated mortality if left undiagnosed. Most of the cases reported have been managed operatively. Here, we present a case of a 75-year-old-female who underwent conservative management for SRFC. Splenic rupture should remain a differential in patients presenting with abdominal pain, syncope, and hypotension following colonoscopy. Decisions regarding operative versus conservative management should be guided by the patient's clinical status, hemodynamics, and available resources.

Case report on severe splenic injury following colonoscopy with disproportionately stable presentation: A rural hospital perspective

INTRODUCTION

Detection of splenic injury following routine colonoscopy is slowly on the rise. Mostly presenting as left upper abdominal or shoulder tip pain along with a sharp fall in haemoglobin level and hemodynamic instability, sometimes the presentation and initial workup may be vague and falsely reassuring.

CASE PRESENTATION

This is demonstrated in the case of a 72 year old male who presented with vague but severe left lower abdominal pain following colonoscopy, during which one caecal polyp was removed and no intraoperative complications were reported. On emergency presentation, abdominal examination was not particularly concerning with only mild left lower tenderness and minimal guarding. Vital signs remained largely normal and blood counts were reasonable. Close to being discharged, patient demonstrated brief hypotension post ambulation which was easily reversed with a fluid bolus. Upon surgical review, a high index of suspicion prompted further investigation which revealed an unsuspected complication necessitating urgent laparotomy and splenectomy.

DISCUSSION

Splenic injury is slowly becoming an increasingly reported complication following colonoscopy. While many cases present with typical features, others may only display subtle signs of deterioration, and warrant a high degree of suspicion.

CONCLUSION

Rural doctors should be aware of and able to recognise this potentially fatal complication to ensure timely successful management.

Post-polypectomy coagulation syndrome: a tricky to diagnose hot snare problem that can be eliminated thanks to cold snare revolution

Post-polypectomy syndrome or post-polypectomy coagulation syndrome (PPCS) is a rare adverse event of thermal injury caused during hot snare aided, endoscopic mucosal resection of colon polyps. Its diagnosis is tricky as it is commonly misdiagnosed as perforation leading to unnecessary exploratory abdominal surgeries. The authors aim to present an early diagnosed and successfully treated, case of PPCS, and to highlight the difference in the safety profile of two techniques; hot snare versus cold snare polypectomy.

STEMI secondary to splenic rupture after colonoscopy

We have read with interest the recently published case on splenic rupture after colonoscopy. Although this complication is being observed more frequently, in the case presented here, the particularity lies in the myocardial ischemia caused as a consequence of stasis at coronary level, determining a situation of extreme gravity, a diagnostic challenge and a therapeutic emergency.

Splenic Injury Following Colonoscopy: A Case Report

Introduction

Colonoscopy is a commonly performed outpatient procedure with a low risk of complications. The most common complications seen in the postoperative period include hemorrhage and perforation. Infrequently, splenic injury can occur.

Case Report

A 72-year-old male presented with a one-day history of left upper quadrant pain following colonoscopy. During the procedure he had two polyps removed along the transverse colon near the splenic flexure. There were no complications during the procedure or in the immediate post-operative period. On presentation to the emergency department, abdominal tenderness was present in the left upper quadrant without rebound, rigidity, or guarding. Point-of-care ultrasound of the abdomen demonstrated mixed hypoechoic densities confined to the splenic capsule, and computed tomography of the abdomen and pelvis with intravenous contrast noted a grade II/III splenic laceration without active extravasation. The patient was admitted for serial abdominal examination and labs.

Conclusion

Splenic injury following colonoscopy is a rare complication of colonoscopy. Emergency providers should be aware of this possible complication, and acute management should include basic trauma care and consultation for possible intervention, if warranted.

First splenic rupture following an endoscopic esophageal myotomy: A case report

BACKGROUND

The occurrence of splenic rupture is extremely rare during an upper gastro-intestinal endoscopy. Although infrequent, splenic rupture is a known complication secondary to colonoscopy. However, occurrence of splenic rupture after peroral endoscopic myotomy (POEM) has never been reported to date.

CASE SUMMARY

We describe a case of a splenic rupture following a POEM for recurrent achalasia in a patient who previously had a Heller myotomy. Splenic rupture remains very uncommon after an upper gastro-intestinal endoscopic procedure. The most plausible cause for this rare splenic injury appears to be the stretching of the gastro-splenic ligament during the endoscopy. A previous surgery may be a risk factor contributing to this complication.

CONCLUSION

The possibility for the occurrence of specific complications, such as splenic rupture, does exist even with the development of advanced endoscopic procedures, as presented in the present case after POEM.

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

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.

A Case of Iatrogenic Splenic Injury Following Routine Colonoscopy With Possible Influence of Unique Anatomy Due to Severe Scoliosis

Iatrogenic splenic injury is a rare complication of all abdominal surgeries. Despite the procedure's overall safety, colonoscopy is now the procedure most frequently associated with iatrogenic splenic injury. A 58-year-old male with a past medical history of hypertension, lung cancer in remission, colon polyps, and severe scoliosis presented for grade three splenic laceration two days following a routine colonoscopy. He had no recent history of injury or other inciting events that could have led to traumatic injury. Non-operative management included splenic artery embolization and transfusion of one unit of packed red blood cells, after which he improved in the hospital and was discharged home in stable condition. This case postulates the possible influence of his severe scoliosis, and thus altered abdominal viscera anatomy, on his iatrogenic splenic injury, as well as the potential importance of investigating scoliosis as a risk factor for difficult colonoscopy or even iatrogenic splenic injury during colonoscopy.

Conservative Treatment of Splenic Haematoma After Colonoscopy: A Case Report

Colonoscopy is a routine procedure performed worldwide, nevertheless, a small risk of splenic injury, often under-estimated, is still present. As a matter of fact, the diagnosis may be delayed, leading to a rising risk of morbidity and mortality. This paper describes a case of conservative treatment of colonoscopy-associated splenic injury.

A 57-year-old woman presented with worsening pain in the upper left abdominal quadrant; she had radiation therapy to the ipsilateral subscapular region, and a diagnostic colonoscopy 18 hours earlier.

The computed tomography (CT) scan revealed splenic laceration without signs of hemoperitoneum. Because of the hemodynamic stability of the patient, successful conservative treatment and serial controls of the blood and hemodynamic parameters were adopted.

Even if rare splenic injury during colonoscopy is associated with significant morbidity and mortality. A high degree of clinical suspicion is essential to achieve a prompt diagnosis as well as an early surgical evaluation.

The nonoperative approach is usually taken in patients with no intraperitoneal bleeding, a closed subcapsular haematoma and a stable hemodynamic status.

Splenic trauma from colonoscopy: A case series

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There are 170 cases of post colonoscopy splenic injury reported in the literature.

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Management should be dictated by the patient’s clinical status and adhere to traumatic blunt splenic injury guidelines.

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Awareness of risk factors and post-procedure vigilance leads to prompt detection and intervention for this rare complication.

Introduction

Splenic trauma is quite rare after colonoscopy and can be overlooked as a complication when a patient presents with severe abdominal pain. It can be difficult to diagnose without appropriate imaging, but it should be considered as part of the differential in a patient arriving for evaluation of left upper quadrant abdominal pain.

Presentation of case

In this case series, we discuss four patients who presented to our institution with splenic trauma specifically after colonoscopy. These patients were diagnosed with splenic trauma utilizing computed tomography (CT) scans of the abdomen and pelvis. They were all immediately transferred to our surgical intensive care unit (SICU) for close monitoring and serial hemoglobin checks. Two of the four patients had decreasing hemoglobin levels and were monitored until they underwent interventional radiology (IR) angiography and angioembolization. The other two patients had significant transfusion requirements and ultimately went to the operating room for an open splenectomy. All four of these patients did well after their interventions, although one of them required longer hospitalization while on the ventilator secondary to Haemophilus infection.

Discussion

This case series recognizes that there is potential for quite severe splenic trauma after colonoscopy. While one of the four patients did have a history of prior splenic trauma, the other three had no history of trauma.

Conclusion

These cases demonstrate that this complication should be managed similarly to traumatic splenic injury unrelated to colonoscopy, and that non-operative treatment remain a possibility. Certainly, non-operative management requires a SICU and IR capabilities to be successful. If the patient becomes unstable, they should undergo the appropriate operative intervention.

Splenic injury: a rare complication of lower endoscopy

Splenic injury after colonoscopy is a rare (1:100 000) but serious complication after colonoscopy associated with high morbidity. Consequences range from a mild, self-limited splenic haematoma to the catastrophic shattered spleen and haemorrhagic shock. We present a case of a 68-year-old woman reporting to the emergency department with abdominal pain after colonoscopy. Abdominal CT with intravenous contrast showed a grade I splenic laceration with no active bleeding and a small amount of free fluid collected in the pelvis. General Surgery and Hospitalist Service recommended conservative measures. She was discharged 1 day later with normal haemodynamics and adequate pain control. In conclusion, patients with postcolonoscopy complications often seek evaluation in the emergency department; splenic injury must be considered in the differential. The significant morbidity and occasional mortality are reported from spleen injury after colonoscopy; therefore, the treating physician should promptly evaluate and treat this condition (with appropriate specialty consultation) to prevent untoward outcomes.

A Delayed Splenic Tragedy Beyond the Scope of a Colonoscope: A Rare Find

Colonoscopy is considered a low-risk procedure worldwide. Complications include hemorrhage, bowel perforation, and splenic rupture on rare occasions. The incidence of splenic rupture estimates between 0.00005 and 0.017%. Due to its nonspecific presentation, many cases may be misdiagnosed. We present a 76-year-old female on apixaban for atrial fibrillation who presented to us with sudden-onset, left-sided atraumatic chest pain radiating to the left shoulder, 10/10 in intensity, associated with nausea. The patient underwent an uncomplicated colonoscopy 16 days earlier with the excision of a 1.3 cm polyp. On presentation, her blood pressure was 96/58 mmHg, hemoglobin of 7.2, an international normalized ratio (INR) of 1.6. An abdominal computed tomography scan showed findings suspicious for splenic rupture. In the emergency department, two packed red blood cells (PRBCs) were transfused, and the patient was shifted to the operating room for emergent exploratory laparotomy where a splenectomy was performed for splenic rupture. The patient was discharged six days later without any postoperative complications. We speculate the use of apixaban and our patient's unusual site of pain following splenic rupture to be somehow correlated.

Splenic injuries secondary to colonoscopy: Rare but serious complication

BACKGROUND

Colonoscopy is a safe and routine diagnostic and therapeutic procedure for evaluation of large bowel diseases. Most common procedure related complications include bleeding and perforation but rarely a splenic Injury.

AIM

To investigate the reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients

METHODS

A structured search on four databases was done and 45 articles with 68 patients were selected. The reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients were identified and analyzed using SPSS.

RESULTS

The mean age of the patients was 62.7 years with 64% females. Twenty two percent had a complete splenic rupture with colonoscopy while 63% had subcapsular hematoma, spleen laceration and spleen avulsion. The most common reason for colonoscopy was screening (46%) followed by diagnostic colonoscopy (28%). Eighty seven percent of patients presented with abdominal pain. Patients with spleen rupture mostly required splenectomy (47%), while minor spleen hematomas and lacerations were managed conservatively (38%). Six percent of the patients were managed with proximal splenic artery splenic embolization and 4% were managed with laparoscopic repair. The overall mortality was 10% while 77% had complete recovery. The reason of colonoscopy against presentation specifically, abdominal pain showed no statistical significance P = 0.69. The indication of colonoscopy had no significant impact on incidence of splenic injury (P = 0.89). Majority of the patients (47%) were managed with splenectomy while the rest were managed conservatively (P = 0.04). This association was moderately strong at a cramer’s V test (0.34). The Fisher exact test showed a higher mortality with spleen rupture (P = 0.028).

CONCLUSION

Spleen rupture due to colonoscopy is a significant concern and is associated with high mortality. The management of the patients can be individualized based on clinical presentation.

Splenic Hematoma as a Rare Complication of Colonoscopy; a Case Report

Splenic injuries after colonoscopy are an uncommon complication, which can lead to potentially unfortunate outcomes. Their management depends on the type of the splenic damage (hematomas, lacerations, rupture). We describe the case of a woman who visited the Emergency Department due to abdominal pain and pre-syncopal condition, which had occurred 12 hours after she underwent a colonoscopy. An abdominal computed tomography scan showed a splenic hematoma and a hemoperitoneum. An emergency splenectomy was performed successfully. Emergency physicians, who are at the forefront of diagnosing and treating patients, should consider this post-endoscopic complication in order to implement a prompt treatment.

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

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.

The analysis of outcomes of surgical management for colonoscopic perforations: A 16-years experiences at a single institution

BACKGROUND/OBJECTIVE

Colonoscopy-induced colonic perforation often requires surgical management. The aim of this study was to analyze the outcomes after surgery for colonoscopic perforations (CPs).

METHODS

This was a retrospective chart review study of 48 patients who underwent surgery for CPs between January 2002 and May 2017. The patients were divided into two groups: Group I (n = 25) had diagnostic CPs, and Group II (n = 23) had therapeutic CPs.

RESULTS

The most common perforation sites in Group I were the sigmoid colon (n = 19; 76.0%), whereas in Group II were the transverse colon (n = 10, 43.5%) and sigmoid colon (n = 10, 43.5%; p = 0.013). The surgeries performed were primary closure (n = 16, [64.0%] Group I; n = 11 [47.8%] Group II) and bowel resection (n = 9 [36.0%] Group I; n = 11 [47.8%] Group II). The rate of temporary stomas was higher in Group II (n = 9, 26.1%) than Group I (n = 2, 8.0%; p = 0.030). The re-perforation rate after surgery was 8.0% (n = 2) in Group I and 8.7% (n = 2) in Group II (p = 0.568). These re-perforation patients all those who had a simple closure without a wedge resection. The conversion rate after laparoscopic surgery was 20.0% (n = 2 of 10) in Group I and 33.3% (n = 1 of 3) in Group II.

CONCLUSIONS

Surgical management is one of the important therapies in the treatment of CP. Simple primary closure without a wedge resection should be used cautiously. Therapeutic CPs was associated with more temporary stoma formation. The type of surgery should be carefully selected, depending on the type of CP.

A Case of Splenic Laceration Presenting as a Delayed Complication of Colonoscopy

BACKGROUND

Colonoscopy is a frequently performed medical procedure; complications associated with this procedure often present to the emergency department (ED). Splenic laceration is a rare but life-threatening complication of colonoscopy. We report the unique case of a patient with a splenic laceration who presented after a recent colonoscopy and had no history of trauma.

CASE REPORT

A 52-year-old man presented to our ED with abdominal pain and lightheadedness the day after a routine colonoscopy. Ultrasound demonstrated hemoperitoneum, and contrast-enhanced computed tomography of the abdomen revealed a large hemoperitoneum with active contrast extravasation from the laceration of the superior pole of the spleen. After resuscitation, the patient was managed with an emergency splenectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Colonoscopy complications are frequently identified and managed in the ED. Splenic laceration should be on the differential for patients that present with abdominal pain or hypotension after colonoscopy. Splenic injury carries a high mortality risk, and prompt, accurate diagnosis can be lifesaving.

A delayed presentation of splenic laceration and hemoperitoneum following an elective colonoscopy: A rare complication with uncertain risk factors

Splenic laceration is a rare yet often underreported complication of colonoscopy that is infrequently discussed with the patient during the consent process. Most cases present within 48 h after the inciting colonoscopy; a delayed presentation is rare. We present a case of splenic laceration with hemoperitoneum that manifested 5 days after the initial colonoscopy. The patient was treated conservatively. Traditionally perceived risk factors such as intra-abdominal adhesions, splenomegaly, anticoagulation use, biopsy, polypectomy, a technically challenging procedure, and anesthesia assistance have not been clearly shown to increase the incidence of splenic injury following a colonoscopy. Since the risk factors of splenic injury remain unclear, the clinical presentation is nonspecific, and the consequences can be serious, the endoscopist should make an effort to inform the patient of this rare complication before the procedure.

Blunt splenic injury during colonoscopy: Is it as rare as we think?

BACKGROUND

Post colonoscopy blunt splenic injury (PCBSI) is a rarely reported and poorly recognized event. We analyzed cases of PCBSI managed at our hospital and compared them to existing literature.

METHODS

We identified 5 patients admitted with PCBSI through chart review.

RESULTS

There were 5 cases of PCBSI identified from April 2016-July 2017. Four of the patients were older than 65 years, three had prior surgeries, and all were women. CT scans showed splenic laceration in 4 cases, hemoperitoneum in 4 cases, and left pleural effusion in 2 cases. Three patients were treated with coil embolization, 1 had open splenectomy, and 1 was observed.

CONCLUSIONS

Although blunt splenic injury is an infrequently reported complication of colonoscopy, it can result in high-grade injury requiring transfusion and invasive treatment due to significant hemorrhage. As previously reported, we demonstrate a high rate of PCBSI in women over 55 with a history of prior abdominal surgery. These data suggest that a high index of suspicion for splenic injury post-colonoscopy should be present in this population.

A register-based study: adverse events in colonoscopies performed in Sweden 2001-2013

OBJECTIVES

The rates for colonoscopy-associated adverse events vary considerably worldwide. In Sweden, the figures are known to a limited extent. We assessed the frequency of severe colonoscopy-related adverse events and the impacts of different risk factors, including the use of general anaesthesia.

MATERIAL AND METHODS

This is a retrospective population-based cohort study of the colonoscopies performed during the years 2001-2013 on adults identified in the Swedish health registers. The rates for bleeding, perforation, splenic injury and 30-day mortality were calculated. Covariates for risks were assessed in a multivariate Poisson regression model.

RESULTS

There were 593,315 colonoscopies performed on the 426,560 individuals included in the study. The rates for colonoscopy-related bleeding and perforation were 0.17% and 0.11%, respectively. When polypectomy was performed, the rates were 0.53% for bleeding and 0.25% for perforation. There were 31 splenic injuries (1:20,000 colonoscopies) reported. The crude 30-day death rate for colonoscopy was 0.68%. Of those diagnosed with bleeding or perforation, 5.6% and 6.1% were dead within 30 days, respectively. The multivariate RR for perforation when general anaesthesia was employed was 2.65 (p < .001; 95%CI 1.71-4.12).

CONCLUSIONS

The perforation rate seemed to be relatively high in an international perspective. General anaesthesia was associated with a significantly higher risk for perforation. Splenic injuries were more frequent than expected.

Splenic laceration after routine colonoscopy, a case report of a rare iatrogenic complication

Colonoscopy is a common and routine procedure performed in the United States, most commonly performed for screening of colorectal cancer. Although colonoscopy is considered a safe procedure, it is associated with complications including intestinal hemorrhage and perforation. Splenic trauma, such as laceration or even complete rupture is a rarely reported, but potentially fatal complication if undetected. We present a case of splenic laceration with subcapsular hematoma status post routine colonoscopy. Fortunately, patient was able to be managed medically, without further operative intervention. We will also review the available literature related to this rare iatrogenic complication.