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

Abstract

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.

Keywords: Colonoscopy; radiology; splenic laceration.

Figure 1

Colonoscopic images showing sigmoid diverticula (A) and a 5 mm sessile polyp at 30 cm (B) from the anal verge.

Figure 2

Contrast-enhanced CT performed in the ED two weeks after the colonoscopy. Axial as well as coronal and sagittal reformatted images showing a grade II splenic injury. A 1.8 cm, linear hypodense line is seen at the lateral aspect of the spleen on the coronal reformatted image (arrow). There is no evidence of extracapsular hemorrhage, such as fluid in the left paracolic gutter.

Figure 3

Follow up imaging of the spleen 7 days after patient discharged from the ED using color Doppler ultrasound (A) demonstrating a hypoechoic subcapsular splenic hematoma (marked by calipers) without evidence of active extravasation. Further follow up imaging of the spleen 14 days after patient discharge from the ED using grayscale ultrasound showing continued retraction of the subcapsular hematoma. Again, there is no evidence of extravasation into the hematoma on color Doppler (not shown).