Splenic rupture following colonoscopy: Case report and literature review

Abstract

Introduction: Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for colorectal diseases. Although bleeding and perforation are most common complications, extra colonic or visceral injuries have been described. Splenic rupture is rare with few cases reported in current literature.

Presentation of case: We report the case of a 73-year old man who presented to surgical consultation 50h after colonoscopy. Clinical, laboratory and imaging findings were suggestive for haemoperitoneum. At surgery an almost complete splenic disruption was evident and urgent splenectomy was performed.

Discussion: Splenic injury following colonoscopy is exceptional, probably related to instrumental looping with excessive traction on the splenocolic ligament. In patients with an early presentation a sudden onset of symptoms is the rule. By contrast a delayed presentation (>48h) is nonspecific and subtle with arduous diagnosis.

Conclusion: Awareness of this potential complication, high level of suspicion and prompt treatment are at the basis of better outcomes in such patients.

Keywords: Colonoscopy; Haemoperitoneum; Splenectomy,; Splenic injury grading; Splenic rupture.

Fig. 1

Large sub capsular grade III splenic hematoma (102 × 131 × 140 mm) causing medial organ displacement with consensual haemoperitoneum. No signs of active parenchymal bleeding are appreciable on CT imaging (blush-sign).