Colonoscopy-induced splenic injury: Report of 3 cases and literature review

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.