Abstract
The purpose of this study is to investigate the clinical and CT findings in patients with symptomatic colonoscopy-induced splenic rupture, and to assess for common features among this cohort. Multi-center search yielded 11 adults with symptomatic splenic injury related to colonoscopy. Workup included abdominal CT in 10 (91%) cases and abdominal radiography in two patients (one patient had both). Colonoscopy findings, post-procedural course, and CT findings were systematically reviewed. Mean patient age was 62.2 years (range, 51–84 years); 8 (73%) of 11 were female. The majority (64%) of colonoscopies were for screening. No immediate complications were reported at optical colonoscopy; tortuosity/redundancy was noted in five cases. Except for a small (8 mm) polyp in one case and a large (10 mm) polyp in another, the remaining nine patients had either diminutive or no polyps. Only one patient presented with hemodynamic instability during post-colonoscopy recovery; the other ten had a delayed presentation ranging from 8 h to 8 days (mean, 2.1 days). All 11 patients presented with abdominal pain. CT was diagnostic for splenic injury with subcaspular and/or perisplenic hematoma in all ten CT cases. Hemoperitoneum was present in eight, visible splenic laceration in three cases, and splenic artery pseudoaneurysm in one case. Five patients underwent splenectomy (four emergent) and six patients were treated conservatively. Average hospital stay was 5.5 days (range, 3–10 days). Colonoscopy-induced splenic rupture characteristically presents as a delayed and often serious complication. In cases of apparent non-traumatic splenic hematoma or rupture at CT, eliciting a history of recent colonoscopy may identify the etiology.
Similar content being viewed by others
References
Kim DH, Pickhardt PJ, Taylor AJ, Menias CO (2008) Imaging evaluation of complications at optical colonoscopy. Curr Probl Diagn Radiol 37:165–177
Levin TR, Zhao W, Conell C et al (2006) Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med 145:880–886
Rabeneck L, Paszat LF, Hilsden RJ et al (2008) Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 135:1899–1906
Gatto NM, Frucht H, Sundararajan V, Jacobson JS, Grann VR, Neugut AI (2003) Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst 95:230–236
Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR (2008) Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 143:701–706
Janes SEJ, Cowan IA, Dijkstra B (2005) Lesson of the week—a life threatening complication after colonoscopy. Br Med J 330:889–890
Kamath AS, Iqbal CW, Sarr MG et al (2009) Colonoscopic splenic injuries: incidence and management. J Gastrointest Surg 13:2136–2140
Levine E, Wetzel LH (1987) Splenic trauma during colonoscopy. Am J Roentgenol 149:939–940
Prowda JC, Trevisan SG, Lev-Toaff AS (2005) Splenic injury after colonoscopy: conservative management using CT. Am J Roentgenol 185:708–710
Sarhan M, Ramcharan A, Ponnapalli S (2009) Splenic injury after elective colonoscopy. Jsls-J Soc Laparoendosc Surg 13:616–619
Shatz DV, Rivas LA, Doherty JC (2006) Management options of colonoscopic splenic injury. Jsls 10:239–243
Tse CCW, Chung KM, Hwang JST (1998) Prevention of splenic injury during colonoscopy by positioning of the patient. Endoscopy 30:S74–S75
Saad A, Rex DK (2008) Colonoscopy-induced splenic injury: report of 3 cases and literature review. Dig Dis Sci 53:892–898
Anderson JC, Messina CR, Cohn W et al (2001) Factors predictive of difficult colonoscopy. Gastrointest Endosc 54:558–562
Hanson ME, Pickhardt PJ, Kim DH, Pfau PR (2007) Anatomic factors predictive of incomplete colonoscopy based on findings at CT colonography. AJR Am J Roentgenol 189:774–779
Kim DH, Pickhardt PJ, Taylor AJ et al (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. New Engl J Med 357:1403–1412
Hough DM, Kuntz MA, Fidler JL et al (2008) Detection of occult colonic perforation before CT colonography after incomplete colonoscopy: perforation rate and use of a low-dose diagnostic scan before CO2 insufflation. AJR Am J Roentgenol 191:1077–1081
Pickhardt PJ (2006) Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology 239:313–316
Sosna J, Blachar A, Amitai M et al (2006) Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort. Radiology 239:457–463
Burling D, Halligan S, Slater A, Noakes MJ, Taylor SA (2006) Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom. Radiology 239:464–471
Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, de Garmo P, Fleischer DE (2007) A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc 66:27–34
Pickhardt PJ, Choi JR, Hwang I et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. New Engl J Med 349:2191–2200
Pickhardt PJ, Wise SM, Kim DH (2010) Positive predictive value for polyps detected at screening CT colonography. Eur Radiol 20:1651–1656
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fishback, S.J., Pickhardt, P.J., Bhalla, S. et al. Delayed presentation of splenic rupture following colonoscopy: clinical and CT findings. Emerg Radiol 18, 539–544 (2011). https://doi.org/10.1007/s10140-011-0982-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10140-011-0982-3