Splenic injury in colonoscopy: A review

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 24 h, and 55.8% presented within 24 h. 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. Crown Copyright (C) 2009 Published by Elsevier Ltd on behalf of Surgical Associates Ltd. All rights reserved.