Journal of Gastrointestinal Surgery

, 13:2136

Colonoscopic Splenic Injuries: Incidence and Management

Authors

  • Ashwin S. Kamath
    • Department of GI and General SurgeryMayo Clinic Rochester
  • Corey W. Iqbal
    • Department of GI and General SurgeryMayo Clinic Rochester
  • Michael G. Sarr
    • Department of GI and General SurgeryMayo Clinic Rochester
  • Daniel C. Cullinane
    • Division of Trauma, Critical Care, and General SurgeryMayo Clinic Rochester
  • Scott P. Zietlow
    • Division of Trauma, Critical Care, and General SurgeryMayo Clinic Rochester
  • David R. Farley
    • Department of GI and General SurgeryMayo Clinic Rochester
    • Division of Trauma, Critical Care, and General SurgeryMayo Clinic Rochester
2009 SSAT Poster Presentation

DOI: 10.1007/s11605-009-1064-7

Cite this article as:
Kamath, A.S., Iqbal, C.W., Sarr, M.G. et al. J Gastrointest Surg (2009) 13: 2136. doi:10.1007/s11605-009-1064-7

Abstract

Purpose

Splenic injuries that occur during colonoscopies are rare. There is no available incidence of this serious complication, and the literature is limited to case reports. Our study looks at single institution experience of splenic injuries during colonoscopy to define the incidence and management of this serious complication.

Methods

All patients from 1980 through June 2008 sustaining a splenic injury during colonoscopy were reviewed.

Results

Four patients (of 296,248 colonoscopies) sustained a splenic injury directly from colonoscopy performed at our institution (incidence 0.001%). Three additional patients were treated at our tertiary referral center after splenic injury from colonoscopy performed elsewhere. The mean age at the time of colonoscopy was 54 years (range 40–70 years). The most common presenting symptom was abdominal pain (n = 4) with a mean decrease in hemoglobin of 6.5 g/dl (range 4.5–8.5 g/dl). Splenic injury was diagnosed by computed tomography in five patients. Six patients received a mean of 5.5 U of packed red blood cells (range 2–14 U). All patients were managed with splenectomy, six patients within 24 h of the index colonoscopy, and one patient presented more than 24 h after initial colonoscopy. There was no evidence of preexisting splenic disease in any of the patients by surgical pathology, and there were no postoperative complications or deaths. The mean duration of stay was 10 days (range 7–15 days). All patients are alive at a median follow up of 22 months (range 1–164 months).

Conclusion

Splenic injury occurring during colonoscopy is a rare but serious complication. Patients presented with abdominal pain and a precipitous decrease in hemoglobin and have all required emergent splenectomy.

Keywords

Splenic injuryColonoscopyIatrogenicSplenectomy

Copyright information

© The Society for Surgery of the Alimentary Tract 2009