Splenic rupture post colonoscopy - splenocolic ligament avulsion

Case contributed by Dr Chris O'Donnell

Presentation

Severe abdominal pain, distension and hypotension 24 hours post colonoscopy

Patient Data

Age: 85
Gender: Female

Urgent arterial and delayed phase CT scans to detect bleeding point

Massive haemoperitoneum with sentinel clot around the spleen and contrast leak from the spleen that dilutes on the delayed imaging consistent with active bleeding.  Location of bleeding is between the spleen and splenic flexure = ligament avulsion that has occured at the time of colonoscopic manipulation.

Case Discussion

Splenic injury after colonoscopy is rare, serious, and may become a lethal complication of the procedure. The most likely mechanism is tension on the splenocolic ligament or on pre-existing adhesions due to manipulations of the colon, or as a result of a direct injury to the spleen during passage through the splenic flexure. Intraperitoneal adhesions or any underlying splenic pathology may increase the risk. It is usually diagnosed late since not clinically suspected.

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Case information

rID: 20948
Case created: 23rd Dec 2012
Last edited: 16th Nov 2015
Inclusion in quiz mode: Excluded

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