Skip to main content

Advertisement

SpringerLink
Log in

Diagnosis and management of splenic injury following colonoscopy: algorithm and case series

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Splenic injury following colonoscopy is a rare yet life-threatening complication. These injuries are often associated with delayed diagnosis and may require invasive intervention. We sought to study the emergent presentation associated with splenic injury post-colonoscopy and to suggest a new treatment algorithm.

Methods

Six cases of splenic injury following colonoscopy were collected from three medical centers. Data regarding patient medical history, clinical presentation, laboratory and imaging findings and clinical management were recorded. A systematic PubMed/MEDLINE search was performed. Non-English-language publications and publications dating earlier than 2010 were excluded. An emergency department trauma-based management algorithm was designed according to the identified publications and review of the available trauma literature.

Results

The mean age was 65.3 years and the male-to-female ratio was 1:5. Five of the cases presented within 24 h of the colonoscopy complaining of severe abdominal pain. Hemodynamic instability was noted in four patients who presented with tachycardia (105–130), hypotension and/or a rapid drop in hemoglobin levels. All of the patients underwent initial resuscitation and a computerized abdominal tomography scan. Four of them required emergent splenectomy. No mortality or major morbidity was reported following the hospitalization.

Conclusions

Although very rare, splenic injury during colonoscopy is an acute, severe and possible fatal complication. Patients may present with a rapid clinical deterioration and hemodynamic instability. Physicians should be familiar with the practical management of this surgical emergency and the treatment options available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Suissa A, Bentur OS, Lachter J et al (2012) Outcome and complications of colonoscopy: a prospective multicenter study in northern Israel. Diagn Ther Endosc 2012:612542

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Wherrey DC, Zehner H Jr (1974) Colonoscopy-fiberoptic endoscopic approach to the colon and polypectomy. Med Ann Dist Columbia 43:189–192

    Google Scholar 

  3. Herreros de Tejada A, Giménez-Alvira L, Van den Brule E et al (2014) Severe splenic rupture after colorectal endoscopic submucosal dissection. World J Gastroenterol 20:9618–9620

    PubMed Central  PubMed  Google Scholar 

  4. Lauretta A, Busuito G, Bellomo RE (2014) Splenic injury during colonoscopy: a complication hardly thought hence hardly sought. Am Surg 80:E111–E113

    PubMed  Google Scholar 

  5. Piccolo G, Di Vita M, Cavallaro A et al (2014) Presentation and management of splenic injury after colonoscopy: a systematic review. Surg Laparosc Endosc Percutan Tech 24:95–102

    Article  PubMed  Google Scholar 

  6. Guner A, Kaya U, Kece C, Kucuktulu U (2013) Is non-operative management feasible for splenic injury due to colonoscopy? BMJ Case Rep 16. doi:10.1136/bcr-2013-009286

  7. McBride R, Dasari B, Magowan H, Mullan M, Yousaf M, Mackle E (2013) Splenic injury after colonoscopy requiring splenectomy. BMJ Case Rep 3. doi:10.1136/bcr-2013-009126

  8. Cooper GS, Kou TD, Rex DK (2013) Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med 8:551–556

    Article  Google Scholar 

  9. Rex DK (2013) Colonoscopic splenic injury warrants more attention. Gastrointest Endosc 77:941–943

    Article  PubMed  Google Scholar 

  10. Pineda L, Sarhan M, Suman P, Lloyd-Smith A, Chua A (2013) Splenic rupture after screening colonoscopy. Am Surg 79:E43–E44

    PubMed  Google Scholar 

  11. González-Soler R, Castro-Ortiz E, Lancho-Seco Á et al (2012) Splenic rupture following diagnostic colonoscopy. Rev Esp Enferm Dig 104:219–220

    Article  PubMed  Google Scholar 

  12. Seifman MA, Freeman LA, Tryfonopoulos J (2012) Delayed splenectomy following colonoscopy-associated splenic injury. ANZ J Surg 82:96–97

    Article  PubMed  Google Scholar 

  13. Singla S, Keller D, Thirunavukarasu P et al (2012) Splenic injury during colonoscopy—a complication that warrants urgent attention. J Gastrointest Surg 16:1225–1234

    Article  CAS  PubMed  Google Scholar 

  14. Corcillo A, Aellen S, Zingg T, Bize P, Demartines N, Denys A (2013) Endovascular treatment of active splenic bleeding after colonoscopy: a systematic review of the literature. Cardiovasc Intervent Radiol 36:1270–1279

    Article  PubMed  Google Scholar 

  15. Fishback SJ, Pickhardt PJ, Bhalla S, Menias CO, Congdon RG, Macari M (2011) Delayed presentation of splenic rupture following colonoscopy: clinical and CT findings. Emerg Radiol 18:539–544

    Article  PubMed  Google Scholar 

  16. Bertoglio C, Roscio F, De Luca A, Colico C, Scandroglio I (2012) Delayed presentation of splenic injury following diagnostic colonoscopy. Updates Surg 64:77–79

    Article  PubMed  Google Scholar 

  17. Aslinia FM, Von Rosenvinge EC (2011) Case report: colonoscopy-associated splenic injury in a 56-year-old woman. Am Fam Physician 83:786

    PubMed  Google Scholar 

  18. Sachdev S, Thangarajah H, Keddington J (2012) Splenic rupture after uncomplicated colonoscopy. Am J Emerg Med 30:515.e1–515.e2

    Article  Google Scholar 

  19. Hardy D, Roach M (2010) Hemothorax and splenic hematoma as complications of colonoscopy. Am Surg 76:E39–E40

    PubMed  Google Scholar 

  20. Theodoropoulos J, Krecioch P, Myrick S, Atkins R (2010) Delayed presentation of a splenic injury after colonoscopy: a diagnostic challenge. Int J Colorectal Dis 25:1033–1034

    Article  PubMed  Google Scholar 

  21. Sarhan M, Ramcharan A, Ponnapalli S (2009) Splenic injury after elective colonoscopy. JSLS 13:616–619

    PubMed Central  PubMed  Google Scholar 

  22. DuCoin C, Acholonu E, Ukleja A et al (2010) Splenic rupture after screening colonoscopy: case report and literature review. Surg Laparosc Endosc Percutan Tech 20:e31–e33

    Article  PubMed  Google Scholar 

  23. Pothula A, Lampert J, Mazeh H, Eisenberg D, Shen HY (2010) Splenic rupture as a complication of colonoscopy: report of a case. Surg Today 40:68–71

    Article  PubMed  Google Scholar 

  24. Rasul T, Leung E, McArdle K, Pathak R, Dalmia S (2010) Splenic rupture following routine colonoscopy. Dig Endosc 22:351–353

    Article  PubMed  Google Scholar 

  25. Michetti CP, Smeltzer E, Fakhry SM (2010) Splenic injury due to colonoscopy: analysis of the world literature, a new case report, and recommendations for management. Am Surg 76:1198–1204

    PubMed  Google Scholar 

  26. Desai B (2010) Splenic laceration following routine colonoscopy. South Med J 103:1181–1183

    Article  PubMed  Google Scholar 

  27. Hutchinson B, Heeney A, Conneely J, Traynor O (2010) Splenic laceration following colonoscopy. Ir J Med Sci 179:633–634

    Article  CAS  PubMed  Google Scholar 

  28. Meier RP, Toso C, Volonte F, Mentha G (2011) Splenic rupture after colonoscopy. Am J Emerg Med 29:241.e1–241.e2

    Article  Google Scholar 

  29. Murariu D, Takekawa S, Furumoto N (2010) Splenic rupture: a case of massive hemoperitoneum following therapeutic colonoscopy. Hawaii Med J 69:140–141

    PubMed Central  PubMed  Google Scholar 

  30. Ghevariya V, Kevorkian N, Asarian A, Anand S, Krishnaiah M (2011) Splenic injury from colonoscopy: a review and management guidelines. South Med J 104:515–520

    Article  PubMed  Google Scholar 

  31. Tse CC, Chung KM, Hwang JS (1999) Splenic injury following colonoscopy. Hong Kong Med J 5:202–203

    PubMed  Google Scholar 

  32. Prowda JC, Trevisan SG, Lev-Toaff AS (2005) Splenic injury after colonoscopy: conservative management using CT. AJR Am J Roentgenol 185:708–710

    Article  PubMed  Google Scholar 

  33. Shatz DV, Rivas LA, Doherty JC (2006) Management options of colonoscopic splenic injury. JSLS 10:239–243

    PubMed Central  PubMed  Google Scholar 

  34. Rumstadt B, Schilling D, Sturm J (2008) The role of laparoscopy in the treatment of complications after colonoscopy. Surg Laparosc Endosc Percutan Tech 18:561–564

    Article  PubMed  Google Scholar 

  35. Kamath AS, Iqbal CW, Sarr MG et al (2009) Colonoscopic splenic injuries: incidence and management. J Gastrointest Surg 13:2136–2140

    Article  PubMed  Google Scholar 

  36. Jaboury I (2004) Splenic rupture after colonoscopy. Intern Med J 34:652–653

    Article  CAS  PubMed  Google Scholar 

  37. Stein DF, Myaing M, Guillaume C (2002) Splenic rupture after colonoscopy treated by splenic artery embolization. Gastrointest Endosc 55:946–948

    Article  PubMed  Google Scholar 

  38. Abunnaja S, Panait L, Palesky JA, Macaron S (2012) Laparoscopic splenectomy for traumatic splenic injury after screening colonoscopy. Case Rep Gastroenterol 6:624–628

    Article  PubMed Central  PubMed  Google Scholar 

  39. Stassen NA, Bhullar I, Cheng JD, Eastern Association for the Surgery of Trauma et al (2012) Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73:S294–S300

    Article  PubMed  Google Scholar 

  40. Liu PP, Lee WC, Cheng YF et al (2004) Use of splenic artery embolization as an adjunct to nonsurgical management of blunt splenic injury. J Trauma 56:768–772 (discussion 773)

    Article  PubMed  Google Scholar 

  41. Patient Care Committee of The Society for Surgery of the Alimentary Tract (SSAT) (2005) Surgical treatment of injuries and diseases of the spleen. J Gastrointest Surg 9:453–454

    Article  Google Scholar 

  42. Körner M, Krötz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U (2008) Current role of emergency US in patients with major Trauma. Radiographics 28:225–242

    Article  PubMed  Google Scholar 

  43. McVay MR, Kokoska ER, Jackson RJ, Smith SD (2008) Throwing out the “grade” book: management of isolated spleen and liver injury based on hemodynamic status. J Pediatr Surg 43:1072–1076

    Article  PubMed  Google Scholar 

  44. Testerman GM, Easparam S, Jacome F (2011) Western trauma association blunt splenic injury algorithm is useful in spontaneous rupture of a normal spleen. Am Surg 77:E85–E86

    PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel

      E. Lahat, A. Nevler, O. Zmora & M. Gutman

    2. The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012, Chaim Sheba Medical Center, Tel-Hashomer, Israel

      A. Nevler

    3. Department of Surgery, Barzilai Medical Center, Ashkelon, Israel

      M. Batumsky

    4. Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel

      R. Shapiro

    Authors
    1. E. Lahat
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. A. Nevler
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. M. Batumsky
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. R. Shapiro
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. O. Zmora
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. M. Gutman
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to A. Nevler.

    Ethics declarations

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Ethical approval

    This study was performed following the Declaration of Helsinki guidelines.

    Informed consent

    Consent was obtained from all patients prior to usage of medical data.

    Additional information

    E. Lahat and A. Nevler have contributed equally to the preparation of the manuscript.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Lahat, E., Nevler, A., Batumsky, M. et al. Diagnosis and management of splenic injury following colonoscopy: algorithm and case series. Tech Coloproctol 20, 163–169 (2016). https://doi.org/10.1007/s10151-015-1422-2

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10151-015-1422-2

    Keywords

    Search

    Navigation