Splenic laceration post colonoscopy

Case contributed by Dr John Grieve

Presentation

Family history of colorectal cancer: elective colonoscopy for bowel cancer screening. The colonoscopist reported difficulty with advancing the scope due to significant bowel looping. The scope was passed through to the rectum with the help of manual pressure. No immediate post procedure complication and patient was sent home. Day 1 post-procedure the patient re-presented with severe epigastric pain.

Patient Data

Age: 60 years
Gender: Female

Splenic laceration with large subcapsular hematoma and free fluid extending around the liver and into the pelvis consistent with hemoperitoneum.  This was considered a grade 3 injury on the AAST speen injury scale

No active extravasation of blood demonstrated.

Small splenic cyst with calcification in its wall is noted.

Pathology

A laceration is seen extending horizontally across the surface of the spleen.

Case Discussion

This is a proven case of a splenic injury following colonoscopy.

Colonoscopy is a common and relatively safe procedure most often used to detect colorectal cancer.  Almost 500,000 colonoscopies were performed in Australia last year. Complications may be under-reported but are nevertheless considered rare. The most frequent complication is bowel perforation (0.34 to 2.14%) and bleeding (1.8 to 2.5%). Infrequent complications include pneumothorax, pneumomediastinum, appendicitis and bacteremia with endocarditis, as well as splenic injury as is reported here.

This patient was initially managed conservatively but overnight became haemodynamically unstable and on day 2 underwent open splenectomy.

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