Abstract
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.
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References
Smith LE, Nivatvongs S (1975) Complications in colonoscopy. Dis Colon Rectum 18:214–220
Fruhmorgen P, Demling L (1979) Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany—results of an inquiry. Endoscopy 11:146–150
Macrae FA, Tan KG, Williams CB (1983) Towards safer colonoscopy—a report on the complications of 5,000 diagnostic or therapeutic colonoscopies. Gut 24:376–383
Wherry DC, Zehner H Jr (1974) Colonoscopy-fiberoptic endoscopic approach to the colon and polypectomy. Med Ann Dist Columbia 43:189–192
Tsoraides SS, Gupta SK, Estes NC (2007) Splenic rupture after colonoscopy: case report and literature review. J Trauma 62(1):255–257
Shatz DV, Rivas LA, Doherty JC (2006) Management options of colonoscopic splenic injury. JSLS 10(2):239–243
Goitein D, Goitein O, Pikarski A (2004) Splenic rupture after colonoscopy. Isr Med Assoc J 6:61–62
Weisgerber K, Lutz MP (2005) Splenic rupture after colonoscopy. Clin Gastroenterol Hepatol 3:A24
Tuso P, McElligott J, Marignani P (1987) Splenic rupture at colonoscopy. J Clin Gastroenterol 9:559–562
Bergamaschi R, Arnaud JP (1997) Splenic rupture from colonoscopy. Surg Endosc 11:1133
Ong E, Bohmler U, Wurbs D (1991) Splenic injury as a complication of endoscopy: two case reports and a literature review. Endoscopy 23:302–304
Dodds LJ, Hensman C (1993) Splenic trauma following colonoscopy. Aust N Z J Surg 63:905–906
Tse CC, Chung KM, Hwang JS (1999) Splenic injury following colonoscopy. Hong Kong Med J 5:202–203
Al Alawi I, Gourlay R (2004) Rare complication of colonoscopy. ANZ J Surg 74:605–606
Prowda JC, Trevisan SG, Lev-Toaff AS (2005) Splenic injury after colonoscopy: conservative management using CT. AJR Am J Roentgenol 185:708–710
Ellis WR, Harrison JM, Williams RS (1979) Rupture of spleen at colonoscopy. Br Med J 1:307–308
Johnson C, Mader M, Edwards DM et al (2006) Splenic rupture following colonoscopy: two cases with CT findings. Emerg Radiol 13:47–49
Volchok J, Cohn M (2006) Rare complications following colonoscopy: case reports of splenic rupture and appendicitis. JSLS 10:114–116
Rockey DC, Weber JR, Wright TL et al (1990) Splenic injury following colonoscopy. Gastrointest Endosc 36:306–309
Jaboury I (2004) Splenic rupture after colonoscopy. Intern Med J 34:652–653
Colarian J, Alousi M, Calzada R (1991) Splenic trauma during colonoscopy. Endoscopy 23:48–49
Olshaker JS, Deckleman C (1999) Delayed presentation of splenic rupture after colonoscopy. J Emerg Med 17:455–457
Levine E, Wetzel LH (1987) Splenic trauma during colonoscopy. AJR Am J Roentgenol 149:939–940
Kloer H, Schmidt-Wilcke HA, Schulz U (1984) Splenic rupture as a consequence of coloscopy. Dtsch Med Wochenschr 109:1782–1783
Espinal EA, Hoak T, Porter JA et al (1997) Splenic rupture from colonoscopy. A report of two cases and review of the literature. Surg Endosc 11:71–73
Ahmed A, Eller PM, Schiffman FJ (1997) Splenic rupture: an unusual complication of colonoscopy. Am J Gastroenterol 92:1201–1204
Heath B, Rogers A, Taylor A et al (1994) Splenic rupture: an unusual complication of colonoscopy. Am J Gastroenterol 89:449–450
Gores PF, Simso LA (1989) Splenic injury during colonoscopy. Arch Surg 124:1342
Lekas BJ (2004) Splenic hematoma as a complication of colonoscopy. J Am Geriatr Soc 52:320–321
Doctor NM, Monteleone F, Zarmakoupis C et al (1987) Splenic injury as a complication of colonoscopy and polypectomy. Report of a case and review of the literature. Dis Colon Rectum 30:967–968
Williams C (2003) Insertion technique. In: Waye J, Rex D, Williams C (eds) Colonoscopy: principles and practice, Ch. 29. Blackwell Publishing, Oxford, pp 318–338
Telmos AJ, Mittal VK (1977) Splenic rupture following colonoscopy. JAMA 237:2718
Walshe JJ, Lee JB, Gerbasi JR (1987) Continuous ambulatory peritoneal dialysis complicated by massive hemoperitoneum after colonoscopy. Gastrointest Endosc 33:468–469
Viamonte M, Wulkan M, Irani H (1992) Splenic trauma as a complication of colonoscopy. Surg Laparosc Endosc 2:154–157
Reissman P, Durst AL (1998) Splenic hematoma. A rare complication of colonoscopy. Surg Endosc 12:154–155
Naini MA, Masoompour SM (2005) Splenic rupture as a complication of colonoscopy. Indian J Gastroenterol 24:264–265
Castelli M (1986) Splenic rupture: an unusual late complication of colonoscopy. CMAJ 134:916–917
Rinzivillo C, Minutolo V, Gagliano G et al (2003) Splenic trauma following colonoscopy. G Chir 24:309–311
Anderson JC, Messina CR, Cohn W et al (2001) Factors predictive of difficult colonoscopy. Gastrointest Endosc 54:558–562
Waye JD, Bashkoff E (1991) Total colonoscopy: is it always possible? Gastrointest Endosc 37:152–154
Nivatvongs S, Fryd D, Fang D (1982) How difficult is total colonoscopy. Gastrointest Endosc 28:140
Church JM (1994) Complete colonoscopy: how often? And if not, why not? Am J Gastroenterol 89:556–560
Cirocco WC, Rusin LC (1995) Factors that predict incomplete colonoscopy. Dis Colon Rectum 38:964–968
De Martino P, Conn M, Allen M et al (1993) Factors influencing time to cecum during colonoscopy. Am J Gastroenterol 88:1572
Webb WA (1991) Colonoscoping the difficult colon. Am Surg 57:178–182
Bier JY, Ferzli G, Tremolieres F et al (1989) Splenic rupture caused by colonoscopy. Gastroenterol Clin Biol 13:224–225
Zerbi S, Crippa S, Di Bella C et al (2006) Splenic rupture following colonoscopy in a hemodialysis patient. Int J Artif Organs 29(3):335–336
Janes SE, Cowan IA, Dijkstra B (2005) A life threatening complication after colonoscopy. BMJ 330:889–890
Luebke T, Baldus SE, Holscher AH et al (2006) Splenic rupture: an unusual complication of colonoscopy: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 16:351–354
Taylor FC, Frankl HD, Riemer KD (1989) Late presentation of splenic trauma after routine colonoscopy. Am J Gastroenterol 84:442–443
Moses RE, Leskowitz SC (1997) Splenic rupture after colonoscopy. J Clin Gastroenterol 24:257–258
Coughlin F, Aanning HL (1997) Delayed presentation of splenic trauma following colonoscopy. S D J Med 50:325–326
Boghossian T, Carter JW (2004) Early presentation of splenic injury after colonoscopy. Can J Surg 47:148
Hamzi L, Soyer P, Boudiaf M et al (2003) Splenic rupture following colonoscopy: report of an unusual case in the absence of underlying splenic disease. J Radiol 84:320–322
Holzer K, Thalhammer A, Bechstein WO (2004) Splenic trauma - a rare complication during colonoscopy. Z Gastroenterol 42:509–512
Shah PR, Raman S, Haray PN (2005) Splenic rupture following colonoscopy: rare in the UK? Surgeon 3:293–295
Stein DF, Myaing M, Guillaume C (2002) Splenic rupture after colonoscopy treated by splenic artery embolization. Gastrointest Endosc 55:946–948
Melsom DS, Cawthorn SJ (1999) Splenic injury following routine colonoscopy. Hosp Med 60:65
Couderc LJ, Mosnier H, Soyer P et al (1996) Splenic rupture after colonoscopy. Ann Med Interne (Paris) 147:379
Zenooz NA, Win T (2006) Splenic rupture after diagnostic colonoscopy: a case report. Emerg Radiol 12:272–273
Gruber M (1989) A dialogue with excellence. The power of certainty. Am J Nurs 89:502–503; discussion 503
Pfefferkorn U, Hamel CT, Viehl CT et al (2005) Haemorrhagic shock caused by splenic rupture following routine colonoscopy. Int J Colorectal Dis 22(5):559–560
Reynolds FS, Moss LK, Majeski JA et al (1986) Splenic rupture following colonoscopy. Gastrointest Endosc 32:307–308
Adamek RJ, Wegener M, Schmidt-Heinevetter G et al (1992) Splenic rupture following colonoscopy: an unusual complication. Z Gastroenterol 30:139–141
Merchant AA, Cheng EH (1990) Delayed splenic rupture after colonoscopy. Am J Gastroenterol 85:906–907
Federle MP, Griffiths B, Minagi H et al (1987) Splenic trauma: evaluation with CT. Radiology 162:69–71
Buntain WL, Gould HR, Maull KI (1988) Predictability of splenic salvage by computed tomography. J Trauma 28:24–34
Jeffrey RB, Laing FC, Federle MP et al (1981) Computed tomography of splenic trauma. Radiology 141:729–732
Berger PE, Kuhn JP (1981) CT of blunt abdominal trauma in childhood. AJR Am J Roentgenol 136:105–110
Toombs BD, Lester RG, Ben-Menachem Y et al (1981) Computed tomography in blunt trauma. Radiol Clin North Am 19:17–35
Peitzman AB, Makaroun MS, Slasky BS et al (1986) Prospective study of computed tomography in initial management of blunt abdominal trauma. J Trauma 26:585–592
Federle M (1985) The acute abdomen: computed tomography. RadioGraphics 5:307–322
Mirvis SE, Whitley NO, Gens DR (1989) Blunt splenic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology 171:33–39
Cohen JL, Forde KA (1988) Intraoperative colonoscopy. Ann Surg 207:231–233
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Saad, A., Rex, D.K. Colonoscopy-induced Splenic Injury: Report of 3 Cases and Literature Review. Dig Dis Sci 53, 892–898 (2008). https://doi.org/10.1007/s10620-007-9963-5
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DOI: https://doi.org/10.1007/s10620-007-9963-5