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Galanis I, Simou M. Splenic Injury After Colonoscopy in a 55-Year-Old Female Patient. Cureus 2023; 15:e35239. [PMID: 36968869 PMCID: PMC10038689 DOI: 10.7759/cureus.35239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
Colonoscopy is, in general, a relatively safe procedure with a low complication rate. Splenic injury related to this procedure is very rare, ranging from one in 100,000 to one in 6,387 colonoscopies, but a possibly lethal complication. For its diagnosis, a high degree of clinical suspicion is needed as many physicians are not aware of its existence. Clinical symptoms and signs are observed 1-10 days after the procedure. The imaging modality of choice is contrast-enhanced computed tomography (CECT). However, contrast-enhanced ultrasound (CEUS) may also be used to detect abdominal fluid and the injured area of the spleen. We present a case of a 55-year-old female with splenic rupture after a colonoscopy, diagnosed with CEUS and CECT. Splenectomy was performed, and the patient's recovery was uneventful.
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Nene RV, Chan TC. Elderly woman with abdominal pain. J Am Coll Emerg Physicians Open 2020; 1:1750-1751. [PMID: 33392591 PMCID: PMC7771802 DOI: 10.1002/emp2.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rahul V. Nene
- Department of Emergency MedicineUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Theodore C. Chan
- Department of Emergency MedicineUniversity of California, San DiegoSan DiegoCaliforniaUSA
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Kang YW, Lee JY, Lee JH. Hemoperitoneum with Splenic Artery Rupture Following Diagnostic Colonoscopy. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2020; 76:246-250. [PMID: 33234772 DOI: 10.4166/kjg.2020.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 11/03/2022]
Abstract
Colonoscopy is a safe and extremely popular diagnostic and therapeutic procedure. The most common complications are bleeding and perforation. Hemoperitoneum is a rare complication after a colonoscopy and is usually associated with splenic injury or solid organ pathology. This is potentially serious and can be life threatening. With the increasing number of colonoscopies performed, there has also been an increasing trend in reports of rare complications, such as pneumothorax, pneumomediastinum, appendicitis, small bowel perforation, septicemia, mesenteric tear, retroperitoneal abscess, and hemoperitoneum. This paper reports a unique case of hemoperitoneum after a recent colonoscopy without a splenic rupture or intra-abdominal abnormality, or external trauma. Most hemoperitoneum occurs within 48 hours after the inciting colonoscopy. In the present case, however, hemoperitoneum appeared 10 days after the colonoscopy. This case emphasizes that physicians should consider hemoperitoneum in a differential diagnosis of abdominal pain in patients after colonoscopy.
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Affiliation(s)
- Yeo Wool Kang
- Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Jong Yoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Jong Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
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Presentation and management of splenic injury after colonoscopy: a systematic review. Surg Laparosc Endosc Percutan Tech 2014; 24:95-102. [PMID: 24686342 DOI: 10.1097/sle.0b013e3182a83493] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study reviewed all single experience of splenic injuries after colonoscopy in the last 40 years to define the possible risk factors and the management of this complication. A MEDLINE and a PubMed search was undertaken to identify articles in English, French, Spanish, and Italian from 1974 to 2012 using the key words: "splenic injury," "splenic rupture," and "colonoscopy." Data were analyzed using descriptive statistic. A total of 103 cases have been described in 75 reports. The majority of the patients were women (71.56%) and 6.85% underwent previous pelvic surgery. The mean age was 63 years (range, 29 to 90 y). About 61 of the 103 studies (59.2%) reported the presence or the absence of previous abdominal surgery and within these, only 31 of 61 patients (50.82%) underwent previous abdominal surgery. In this review, over half of the patients with splenic injury underwent colonoscopy for routine surveillance (62.75%), and only one third of the splenic injures were associated with biopsy or polypectomy. The majority of patients (78.57%) developed symptoms within the first 24 hours after colonoscopy and in a minority of cases (21.43%), there was a delayed presentation 24 hours after colonoscopy. Computed tomography was used as the primary modality to make the diagnosis in 69 of 98 cases (70.41%) and as a confirmatory test in many additional cases. Twenty-six of 102 patients (25.49%) were treated by conservative methods, whereas the majority of patients (69.61%) underwent splenectomy as a definitive treatment. Because of possible medicolegal implications, the endoscopists should consider mentioning splenic injury on the consent form of colonoscopy after bowel perforation and bleeding, particularly in higher risk patients.
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Acute colonoscopy-induced splenic rupture presenting to the emergency department. Case Rep Emerg Med 2013; 2013:436874. [PMID: 23476824 PMCID: PMC3588206 DOI: 10.1155/2013/436874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/05/2013] [Indexed: 12/16/2022] Open
Abstract
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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Abunnaja S, Panait L, Palesty JA, Macaron S. Laparoscopic splenectomy for traumatic splenic injury after screening colonoscopy. Case Rep Gastroenterol 2012; 6:624-8. [PMID: 23139653 PMCID: PMC3492969 DOI: 10.1159/000343428] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Colonoscopy is a widespread diagnostic and therapeutic procedure. The most common complications include bleeding and perforation. Splenic rupture following colonoscopy is rarely encountered and is most likely secondary to traction on the splenocolic ligament. Exploratory laparotomy and splenectomy is the most commonly employed therapeutic intervention for this injury reported in the literature. We present the case of a patient with this potentially fatal complication who was treated successfully at our institution. To our knowledge it is the first report in the literature of laparoscopic splenectomy as a successful minimally invasive treatment of splenic rupture following colonoscopy. The patient was a 62-year-old female who underwent screening colonoscopy with polypectomies at the cecum, descending colon and rectum. Immediately following the procedure she developed abdominal pain and had a syncopal episode. Clinical, laboratory and imaging findings were suggestive of hemoperitoneum and a ruptured spleen. A diagnostic laparoscopy was emergently performed and revealed a grade IV splenic laceration and hemoperitoneum. Laparoscopic splenectomy was completed safely and effectively. The patient's postoperative recovery was uneventful. We conclude that splenic rupture after colonoscopy is a rare but dangerous complication. A high index of suspicion is required to recognize it early. Awareness of this potential complication can lead to optimal patient outcome. Laparoscopic splenectomy may be a feasible treatment option.
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Affiliation(s)
- Salim Abunnaja
- The Stanley Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Conn., USA
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Seifman MA, Freeman LA, Tryfonopoulos J. Delayed splenectomy following colonoscopy-associated splenic injury. ANZ J Surg 2012; 82:96-7. [PMID: 22507520 DOI: 10.1111/j.1445-2197.2011.05948.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Singla S, Keller D, Thirunavukarasu P, Tamandl D, Gupta S, Gaughan J, Dempsey D. Splenic injury during colonoscopy--a complication that warrants urgent attention. J Gastrointest Surg 2012; 16:1225-34. [PMID: 22450952 DOI: 10.1007/s11605-012-1871-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 03/07/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Colonoscopy is a safe procedure that is performed routinely worldwide. There is, however, a small but significant risk of splenic injury that is often under-recognized. Due to a lack of awareness about this injury, the diagnosis may be delayed, which can lead to an increased risk of morbidity as well as mortality. This paper presents a comprehensive review of the medical literature on colonoscopy-associated splenic injury and describes the clinical presentation and management of this rare but potentially life-threatening complication. MATERIALS AND METHODS A comprehensive literature search identified 102 patients worldwide, including patients from our experience, with splenic injury during colonoscopy. A meta-regression analysis was completed using a mixed generalized linear model for repeated measures to identify risk factors for this rare complication. RESULTS A total of 75 articles were identified and 102 patients were studied. The majority of the papers were in English (92 %). Only 23.4 % of patients (26/102) were reported prior to the year 2000. Among the patients reported after the year 2000, the majority (84.2 %, 64/76) were reported after 2005. There were more females (76.5 %), median age was 65 years (range, 29-90 years), and most of the colonoscopies were performed without difficulty (66.6 %). Nearly 67 % of patients presented within 24 h of colonoscopy with complaints ranging from abdominal pain to dizziness. The most common symptom was left upper quadrant pain (58 %), and CT scan was found to be the most sensitive tool for diagnosis. Seventy-three patients underwent operative intervention; 96 % of these were treated with splenectomy. Hemoglobin drop of more than 3 gm/dL was identified as the only significant predictor of operative intervention. The overall mortality rate was 5 %. CONCLUSION Splenic injury during colonoscopy is rare; however, it is associated with significant morbidity and mortality. Splenic injury warrants a high degree of clinical suspicion critical to prompt diagnosis, and early surgical consultation is warranted.
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Affiliation(s)
- S Singla
- Department of Surgery, Temple University Hospital, Philadelphia, PA, USA.
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Zandonà C, Turrina S, Pasin N, De Leo D. Medico-legal considerations in a case of splenic injury that occurred during colonoscopy. J Forensic Leg Med 2012; 19:229-33. [PMID: 22520377 DOI: 10.1016/j.jflm.2011.12.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 11/08/2011] [Accepted: 12/27/2011] [Indexed: 02/07/2023]
Abstract
Colonoscopy has became the gold standard diagnostic and therapeutic treatment for rectum and colon diseases. The splenic injury is a rare complication of colonoscopy and relatively few cases (less than 70) have been reported in the literature so far. Here we present a case of splenic rupture identified in an 80 year-old man few hours after an apparently uneventful colonoscopy. Acknowledging a causal relationship between the lesion and the diagnostic procedures, we discuss the possible medico-legal implications with regard to professional liability considering the exceptional nature of such an event and the stance recently taken by the Italian law.
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Affiliation(s)
- Chiara Zandonà
- Department of Public Health and Community Medicine, Institute of Legal Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134 Verona, Italy
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10
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Abstract
Splenic injury is an uncommon complication of colonoscopy. Less than 100 cases are reported in the English language literature. The exact mechanism of injury to the spleen during colonoscopy is unknown; various authors propose several risk factors and possible mechanisms. Splenic injury can be graded or classified according to the extent of laceration and the severity of the resultant hematoma. The management options range from observation to emergency splenectomy. Computed tomography scan is the most important imaging modality to diagnose splenic injury. Early recognition and appropriate management is of paramount importance in the management of this condition. A high index of suspicion in a patient with persistent abdominal pain after colonoscopy is key especially when a perforated viscous is ruled out. This article outlines the clinical presentation of splenic injury after colonoscopy and delineates a management algorithm.
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11
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Bertoglio C, Roscio F, De Luca A, Colico C, Scandroglio I. Delayed presentation of splenic injury following diagnostic colonoscopy. Updates Surg 2011; 64:77-9. [PMID: 21660616 DOI: 10.1007/s13304-011-0086-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 05/30/2011] [Indexed: 12/16/2022]
Abstract
Splenic injury (SI) is a rare complication after colonoscopy, but should be considered in the differential diagnosis of acute abdominal pain following this procedure. We report a case of delayed rupture and review pertinent literature. A 70-year-old patient on oral warfarin intake underwent colonoscopy that diagnosed obstructive rectal cancer and elongated colon conditioning the endoscope's passage. After 48 h, patient experienced sharp abdominal pain with mild peritoneal signs. Contrast-enhanced CT scan evidenced large amount of abdominal-free blood collection from grade II SI. Hypovolemic shock occurred following brief clinical observation. Urgent laparotomic splenectomy and contextual Hartmann's procedure were then carried out. Postoperative course was uneventful and definitive histology confirmed splenic subcapsular haematoma and locally advanced adenocarcinoma. Perforation and bleeding more likely occurred after colonoscopy, while few cases of SI are reported in literature since 1974. Traction on the splenocolic ligament and direct trauma has been advocated as possible causes. Peritoneal adhesions and splenic diseases usually are predisposing factors although not confirmed in our patient. Anticoagulant therapy favoured delayed filling up of subcapsular haematoma while bowel obstruction added further surgical challenge. Rapid onset of hemorrhagic shock required urgent splenectomy that remains the procedure of choice among the literature reviewed.
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Affiliation(s)
- Camillo Bertoglio
- Busto Arsizio General Hospital, Department of General Surgery, Tradate, Italy.
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12
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Splenic rupture after screening colonoscopy: case report and literature review. Surg Laparosc Endosc Percutan Tech 2011; 20:e31-3. [PMID: 20173607 DOI: 10.1097/sle.0b013e3181cc4f62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
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13
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Michetti CP, Smeltzer E, Fakhry SM. Splenic injury due to colonoscopy: analysis of the world literature, a new case report, and recommendations for management. Am Surg 2011; 76:1198-204. [PMID: 21140684 DOI: 10.1177/000313481007601117] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Splenic injury is a rare complication of colonoscopy. Most literature on the topic is case-report based. Our objective was to perform a comprehensive analysis of characteristics of splenic injury due to colonoscopy from available published reports in the world literature, to compare and contrast this entity with that of traumatic splenic injury, and provide recommendations for management based on the analysis. We reviewed the PubMed database without restrictions using the terms splenic trauma after colonoscopy, splenic rupture from colonoscopy, splenic injury following colonoscopy, and splenic complications of colonoscopy, and also reviewed the references from the resulting publications. Retrieved manuscripts (case reports, reviews, and abstracts) were reviewed by two authors, and data extracted for 15 specific characteristics of each patient reported using a standardized data collection tool. Data were analyzed using descriptive statistics. Splenic injury due to colonoscopy is extremely rare as reported in published literature. The majority of patients that seek medical attention have delayed symptoms, and most require splenectomy. Subcapsular hematoma is the most common injury pattern seen. Selection criteria for operative management may be extrapolated from management guidelines for traumatic splenic injury, although nonoperative failure rates are higher for splenic injury due to colonoscopy than for trauma.
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Affiliation(s)
- Christopher P Michetti
- Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, Virginia 22042, USA.
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14
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Vilallonga R, Armengol Miró JR, Baena JA, Dot J, Armengol M. Rotura esplénica después de fibrocolonoscopia. Complicación excepcional. Cir Esp 2010; 87:57-8. [DOI: 10.1016/j.ciresp.2008.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 12/21/2008] [Indexed: 11/27/2022]
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Splenic rupture as a complication of colonoscopy: report of a case. Surg Today 2009; 40:68-71. [PMID: 20037844 DOI: 10.1007/s00595-008-3977-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 12/19/2008] [Indexed: 10/20/2022]
Abstract
Colonoscopy is a common procedure with the rare complication of a splenic injury. The proposed mechanism of injury is excessive splenocolic ligament traction. The diagnosis is made by computed tomography and the treatment is determined by the patient's stability. Here we report a case of splenic injury during colonoscopy with failure to manage conservatively. A review of the literature and suggested guidelines are also provided.
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16
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Kamath AS, Iqbal CW, Sarr MG, Cullinane DC, Zietlow SP, Farley DR, Sawyer MD. Colonoscopic splenic injuries: incidence and management. J Gastrointest Surg 2009; 13:2136-40. [PMID: 19830501 DOI: 10.1007/s11605-009-1064-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 09/29/2009] [Indexed: 01/31/2023]
Abstract
PURPOSE Splenic injuries that occur during colonoscopies are rare. There is no available incidence of this serious complication, and the literature is limited to case reports. Our study looks at single institution experience of splenic injuries during colonoscopy to define the incidence and management of this serious complication. METHODS All patients from 1980 through June 2008 sustaining a splenic injury during colonoscopy were reviewed. RESULTS Four patients (of 296,248 colonoscopies) sustained a splenic injury directly from colonoscopy performed at our institution (incidence 0.001%). Three additional patients were treated at our tertiary referral center after splenic injury from colonoscopy performed elsewhere. The mean age at the time of colonoscopy was 54 years (range 40-70 years). The most common presenting symptom was abdominal pain (n = 4) with a mean decrease in hemoglobin of 6.5 g/dl (range 4.5-8.5 g/dl). Splenic injury was diagnosed by computed tomography in five patients. Six patients received a mean of 5.5 U of packed red blood cells (range 2-14 U). All patients were managed with splenectomy, six patients within 24 h of the index colonoscopy, and one patient presented more than 24 h after initial colonoscopy. There was no evidence of preexisting splenic disease in any of the patients by surgical pathology, and there were no postoperative complications or deaths. The mean duration of stay was 10 days (range 7-15 days). All patients are alive at a median follow up of 22 months (range 1-164 months). CONCLUSION Splenic injury occurring during colonoscopy is a rare but serious complication. Patients presented with abdominal pain and a precipitous decrease in hemoglobin and have all required emergent splenectomy.
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Affiliation(s)
- Ashwin S Kamath
- Department of GI and General Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA
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Skipworth JRA, Raptis DA, Rawal JS, Olde Damink S, Shankar A, Malago M, Imber C. Splenic injury following colonoscopy--an underdiagnosed, but soon to increase, phenomenon? Ann R Coll Surg Engl 2009; 91:W6-11. [PMID: 19416579 DOI: 10.1308/147870809x400994] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION We present a case of splenic rupture in a 71-year-old woman admitted 6 days following a diagnostic colonoscopy. She underwent an open splenectomy and made a delayed, but complete, recovery. We proceeded to perform a retrospective review of all relevant literature to assess the frequency of similar post-colonoscopy complications. MATERIALS AND METHODS Using relevant keywords, we identified 63 further PubMed reports of splenic injury associated with colonoscopy that were reported in English. FINDINGS We have described only the fourth report of splenic injury secondary to colonoscopy from a UK centre. Literature review reveals a mean age of 63 years and a female preponderance for this complication. Most patients present on the day of their colonoscopy with abdominal pain, anaemia, elevated white cell count and Kehr's sign. CT is the investigation of choice and splenectomy the definitive management of choice. Most patients make a routine recovery, with mortality rates of approximately 8%. There is likely to be an under-reporting of this complication from UK-based centres, with the majority of reports originating from Europe and US. This points to a possible under-diagnosis or under-recognition of this potentially fatal complication. The incidence of such post-colonoscopic complications may increase with the forthcoming introduction of the National Bowel Cancer Screening Programme.
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Affiliation(s)
- J R A Skipworth
- Department of Hepatopancreaticobiliary Surgery, University College Hospital, London, UK.
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18
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Ha JF, Minchin D. Splenic injury in colonoscopy: a review. Int J Surg 2009; 7:424-7. [PMID: 19638324 DOI: 10.1016/j.ijsu.2009.07.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 07/22/2009] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Splenic rupture secondary to colonoscopy was first reported in 1974 by Wherry and Zehner. It has an incidence of around 0.00005-0.017%, and a mortality rate of 5%. METHOD We performed a literature search to identify the demographic profile, risk factors, clinical presentations, diagnosis and management of this rare complication. RESULTS There were 66 patients (51 females and 14 males), with a median age of 65. The mortality rate was 4.5%. Majority (n=41, 62.1%) occurred in uneventful colonoscopies. Symptoms usually (74%) occurred within 24h, and 55.8% presented within 24h. Majority (93.9%) had some form of work-up done, with blood tests (78.8%) and CT (68.2%) being the most frequent. Laparotomy and splenectomy were done in over half (56.1%) of the patients. Splenic hematoma (47%), laceration (47%) and rupture (33.3%) were the most common findings. CONCLUSION Splenic injury is an important complication to be aware of as its number will continue to rise with the increasing numbers of colonoscopies being performed for colorectal diseases, and delayed diagnosis may result in adverse outcome for the patient.
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Affiliation(s)
- Jennifer Fong Ha
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands 6009, Western Australia, Australia.
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Famularo G, Minisola G, De Simone C. Rupture of the spleen after colonoscopy: a life-threatening complication. Am J Emerg Med 2008; 26:834.e3-4. [PMID: 18774051 DOI: 10.1016/j.ajem.2008.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 12/28/2007] [Accepted: 01/01/2008] [Indexed: 10/21/2022] Open
Abstract
During colonoscopy, the risk of injuring the spleen or other viscera except the colon is negligible. We report here a patient in whom spleen rupture did complicate the very early course of colonoscopy, but this remains an extremely rare complication with no more than 50 cases so far described. Diagnosis may be difficult, and the risk of spleen rupture seems to be greatest within 24 hours of colonoscopy. Mechanisms leading to spleen injury in the setting of colonoscopy are unclear; however, direct trauma, colon distension by insufflated air, and the excessive traction on the splenocolic ligament may be involved. Patients with splenomegaly and those with preexisting adhesions are at greater risk for this complication. Patients complaining of persistent abdominal pain after colonoscopy should be closely monitored and aggressively investigated for the suspect of spleen injury and rupture.
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Affiliation(s)
- Giuseppe Famularo
- Department of Internal Medicine, San Camillo Hospital, Circonvallazione Gianicolense, 00152 Rome, Italy.
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20
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Saad A, Rex DK. Colonoscopy-induced splenic injury: report of 3 cases and literature review. Dig Dis Sci 2008; 53:892-8. [PMID: 17934832 DOI: 10.1007/s10620-007-9963-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 08/01/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND Since its first report in 1974, 66 cases of splenic injury after colonoscopy have been reported in the world literature. Splenic injury is among the rarest complications of colonoscopy. However, it can be associated with severe morbidity and has rarely been fatal. OBJECTIVES Three cases of splenic injury following colonoscopy are described, and the world literature is reviewed. METHODS Case reports and literature review. RESULTS Seventy-six percent of the patients were females. When reported, colonoscope insertion was technically difficult in 36% of cases. The onset of symptoms is usually within 48 h of colonoscopy. Abdominal pain was the most common presenting symptom (93% of cases). CT scan and ultrasound each had 100% diagnostic sensitivity when performed. Twenty of 65 cases (31%) with available data were successfully managed supportively with bed rest, transfusion and pain control. Hemodynamic instability was associated with surgical treatment, but no clinical features were perfect predictors of successful conservative therapy or the need for surgery. CONCLUSIONS Splenic injury during and after colonoscopy is more common in women. Technically difficult colonoscopy is a possible risk factor. Onset of symptoms is often delayed by hours. CT scan is probably the best diagnostic test for splenic injury after colonoscopy, though the literature indicated ultrasound is also sensitive. Patients with hemodynamic instability are most often operated. Patients with confined intrasplenic hematoma and hemodynamic stability can be given a trial of conservative management.
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Affiliation(s)
- Abdo Saad
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 N. University Boulevard UH 4100, Indianapolis, IN 46202, USA
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Cappellani A, Di Vita M, Zanghì A, Cavallaro A, Alfano G, Piccolo G, Lo Menzo E. Splenic rupture after colonoscopy: Report of a case and review of literature. World J Emerg Surg 2008; 3:8. [PMID: 18261241 PMCID: PMC2279110 DOI: 10.1186/1749-7922-3-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 02/09/2008] [Indexed: 11/25/2022] Open
Abstract
Splenic rupture is a rare complication of colonoscopy. For this reason the diagnosis could be delayed and the outcome dismal. Fifty-four cases of splenic rupture after colonoscopy have been described in the literature. The majority of the cases required emergent or delayed splenectomy, 13 of these cases were treated conservatively. The main feature that stands out from the review of the literature is the "surprise" of this unexpected complication. This factor explains the elevated mortality (2 out of 54 cases), likely due to the delay in diagnosis. The case here described is probably among the most complex published in the literature; in fact the presence of dense intra-abdominal adhesions not only contributed to the complication itself, but also explain the confinement of the hemoperitoneum to the left supra-mesocolic space and the delayed presentation (13 days from the time of the trauma).
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Affiliation(s)
- Alessandro Cappellani
- University of Catania Medical School, Policlinico, Department of Surgery, Catania, Italy
| | - Maria Di Vita
- University of Catania Medical School, Policlinico, Department of Surgery, Catania, Italy
| | - Antonio Zanghì
- University of Catania Medical School, Policlinico, Department of Surgery, Catania, Italy
| | - Andrea Cavallaro
- University of Catania Medical School, Policlinico, Fellowship in Surgical Physio-Pathology, Catania, Italy
| | - Giovanni Alfano
- University of Catania Medical School, Policlinico, Department of Surgery, Catania, Italy
| | - Gaetano Piccolo
- University of Catania Medical School, Policlinico, Department of Surgery, Catania, Italy
| | - Emanuele Lo Menzo
- University of Miami, Miller School of Medicine, Department of Surgery, Miami, Florida, USA
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Tsoraides SS, Gupta SK, Estes NC. Splenic Rupture After Colonoscopy: Case Report and Literature Review. ACTA ACUST UNITED AC 2007; 62:255-7. [PMID: 17215767 DOI: 10.1097/ta.0b013e31802dc947] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Luebke T, Baldus SE, Holscher AH, Monig SP. Splenic Rupture: An Unusual Complication of Colonoscopy. Surg Laparosc Endosc Percutan Tech 2006; 16:351-4. [PMID: 17057581 DOI: 10.1097/01.sle.0000213703.94687.50] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Splenic rupture after colonoscopy is rare. Only 44 cases previously have been reported in the English literature. Partial capsular avulsion is the proposed mechanism of injury. Any condition causing increased splenocolic adhesions may be a predisposing factor to splenic injury. One case of splenic injury after colonoscopy is reported in addition to a complete review of the literature.
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Affiliation(s)
- Thomas Luebke
- Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
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24
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Johnson C, Mader M, Edwards DM, Vesy T. Splenic rupture following colonoscopy: two cases with CT findings. Emerg Radiol 2006; 13:47-9. [PMID: 16915394 DOI: 10.1007/s10140-006-0519-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 04/21/2006] [Indexed: 11/27/2022]
Abstract
Splenic injury following colonoscopy is extremely rare. We report a 75-year-old woman and a 35-year-old woman who presented to the emergency room with left upper quadrant and left shoulder pain following colonoscopy. Both patients were diagnosed by computed tomography (CT) with splenic injuries and hemoperitoneum. One patient was successfully managed conservatively, and one patient needed emergent open splenectomy. The possibility of splenic injury should be considered in post-colonoscopy patients with left upper quadrant or left shoulder pain.
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Affiliation(s)
- Craig Johnson
- Department of Diagnostic Radiology, Northeastern Ohio Universities College of Medicine-Canton Affiliated Hospitals, 2600 Sixth Street S.W., Canton, OH 44710, USA.
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25
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Prowda JC, Trevisan SG, Lev-Toaff AS. Splenic injury after colonoscopy: conservative management using CT. AJR Am J Roentgenol 2005; 185:708-10. [PMID: 16120923 DOI: 10.2214/ajr.185.3.01850708] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Joan C Prowda
- Department of Radiology, Columbia University Medical Center, New York, NY 10032, USA.
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26
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Abstract
Splenic injury following colonoscopy is rare, with only 28 cases reported so far in the English language literature. Direct trauma during colonoscopy or traction on the spleno-colic ligament is the proposed mechanism of injury. Computed tomography (CT) of the abdomen is usually considered to be the most sensitive and specific modality for diagnosis. We report a case of a 56-year-old female, who was diagnosed having a splenic rupture following a routine colonoscopy for investigation of anaemia. She underwent an emergency laparotomy with splenectomy and made a satisfactory recovery post-operatively. We wish to highlight that there should be a high index of suspicion of splenic rupture in patients presenting with abdominal pain and demonstrating a positive Kehr's sign following colonoscopy. Only two case reports from the United Kingdom have been published, raising the possibility of under-reporting of such cases.
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Affiliation(s)
- P R Shah
- Department of Surgery, Prince Charles Hospital, Pontypridd, Wales, UK
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27
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Fernández-Aceñero MJ, Silvestre V, Portillo JM. Rupture splénique après coloscopie: une complication rare. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/bf03003928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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29
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Stein DF, Myaing M, Guillaume C. Splenic rupture after colonoscopy treated by splenic artery embolization. Gastrointest Endosc 2002; 55:946-8. [PMID: 12024163 DOI: 10.1067/mge.2002.124639] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- David F Stein
- Department of Gastroenterology, St. Barnabas Hospital, Weill Medical College of Cornell University, Bronx, New York, USA
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30
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Weiss SJ, Smith T, Laurin E, Wisner DH. Spontaneous splenic rupture due to subcutaneous heparin therapy. J Emerg Med 2000; 18:421-6. [PMID: 10802418 DOI: 10.1016/s0736-4679(00)00157-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report a case of spontaneous splenic rupture in a 59-year-old woman who was receiving 15,000 units of heparin subcutaneously (s.c. ) twice a day for deep venous thrombosis (DVT) prophylaxis. Her past medical history included multiple DVT, pulmonary emboli, and ovarian cancer stage III-C with known ascites. The diagnosis of splenic rupture was initially missed because of the ascites. This case illustrates both a previously undescribed complication of s.c. heparin therapy and a failure of ultrasound diagnosis. We emphasize the unique presentation, difficulty in diagnosis, and need for early surgical involvement to ensure the most favorable outcome.
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Affiliation(s)
- S J Weiss
- Division of Emergency Medicine, University of California, Davis, Medical Center, Sacramento, California 95817, USA
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