Splenic rupture post colonoscopy - splenocolic ligament avulsion
Severe abdominal pain, distension and hypotension 24 hours post colonoscopy
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Urgent arterial and delayed phase CT scans to detect bleeding pointMassive hemoperitoneum 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.
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.
- 1. R Arrangoiz, A Damadi, A Saxe. Splenic Injury Following Colonoscopy: A Case Report and Literature Review. The Internet Journal of Surgery. 2008 Volume 18 Number 2.
- 2. Sarhan M, Ramcharan A, Ponnapalli S. Splenic injury after elective colonoscopy. JSLS. 2010;13 (4): 616-9. Free text at pubmed - Pubmed citation