Management options of colonoscopic splenic injury

Abstract

Injury to the spleen during routine colonoscopy is an extremely rare injury. Diagnosis and management of the injury has evolved with technological advances and experience gained in the management of splenic injuries sustained in trauma. Of the 37 reported cases of colonoscopic splenic injury, 12 had a history of prior surgery or a disease process suggesting the presence of adhesions. Only 6 had noted difficulty during the procedure, and 31 patients experienced pain, shock, or hemoglobin drop as the indication of splenic injury. Since 1989, 21/24 (87.5%) patients have been diagnosed initially using computed tomography or ultrasonography. Overall, only 27.8% have retained their spleens. None have experienced as long a delay as our patient, nor have any had an attempt at percutaneous control of the injury. This report presents an unusual case of a rare complication of colonoscopy and the unsuccessful use of one nonoperative technique, and reviews the experience reported in the world literature, including current day management options.

Figure 1.

Presenting computed tomographic scan of patient with large undrained hemorrhagic splenic cyst abutting the left lateral abdominal wall.

Figure 2.

Complete collapse of hemorrhagic splenic cyst following computed tomography-guided percutaneous drainage. Drainage catheter is visible lateral to the spleen.

Figure 3.

Pathologic specimen of intact spleen and associated hemorrhagic cyst.

Figure 4.

Pathologic specimen of divided spleen and associated hemorrhagic cyst.