Am Fam Physician. 2011 Apr 1;83(7):786-792.
to the editor: A 56-year-old woman presented to the emergency department with left-sided pleuritic chest pain and upper abdominal pain that began the previous day after a reportedly uneventful diagnostic colonoscopy for occult blood positivity. The colonoscopy was done under propofol sedation and the only abnormal finding was mild diverticulosis of the left colon. On presentation to the emergency department, vital signs were normal and physical examination was notable for obesity and mild tenderness to palpation in the left upper abdominal quadrant. Laboratory tests revealed a hemoglobin level of 11.4 g per dL (114 g per L), International Normalized Ratio of 0.95, normal white blood cell and platelet counts, and normal blood chemistries. Computed tomography (CT) of the abdomen and pelvis with contrast (see accompanying figure) revealed a large splenic hematoma and an incidental hepatic cyst. She was treated conservatively and her symptoms gradually improved. A follow-up CT scan three days later showed no progression of the hematoma.
Splenic injury during colonoscopy is uncommon but can lead to splenic hematoma, splenic rupture, hemoperitoneum, and potentially death. Patients typically present within hours to several days after the procedure with abdominal pain and symptoms of hemodynamic instability.1 Possible predisposing factors include adhesions involving the splenocolic ligaments, splenomegaly, looping at the splenic flexure, excessive externally applied abdominal pressure, female sex, rapid completion time, smoking, propofol sedation, inadequate colon cleansing, and aspirin use.1–3 Imaging modalities such as ultrasonography and CT scan of the abdomen and pelvis with contrast are typically diagnostic.1,4 Based on the extent of the splenic injury and hemodynamic status, conservative management, splenic artery embolization, or surgical interventions are reported to be effective.1–5
Diagnosis of colonoscopy-associated splenic injury requires a high index of clinical suspicion and prompt abdominal imaging in a patient with unexplained abdominal pain or symptoms of hemodynamic instability after colonoscopy. It is important that colonoscopists, including family physicians who perform this procedure,6 recognize colonoscopy-associated splenic injury in a timely manner.
Author disclosure: Nothing to disclose.
1. Saad A, Rex DK. Colonoscopy-induced splenic injury: report of 3 cases and literature review. Dig Dis Sci. 2008;53(4):892–898.
2. Guerra JF, San Francisco I, Pimentel F, Ibanez L. Splenic rupture following colonoscopy. World J Gastroenterol. 2008;14(41):6410–6412.
3. Rao KV, Beri GD, Sterling MJ, Salen G. Splenic injury as a complication of colonoscopy: a case series. Am J Gastroenterol. 2009;104(6):1604–1605.
4. Olshaker JS, Deckleman C. Delayed presentation of splenic rupture after colonoscopy. J Emerg Med. 1999;17(3):455–457.
5. Stein DF, Myaing M, Guillaume C. Splenic rupture after colonoscopy treated by splenic artery embolization. Gastrointest Endosc. 2002;55(7):946–948.
6. American Academy of Family Physicians. Colonoscopy (position paper). http://www.aafp.org/about/policies/all/colonoscopy.html. Accessed July 30, 2010.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2011 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions