Résumé
La coloscopie à visée diagnostique et/ou thérapeutique est un examen invasif fréquemment pratiqué de nos jours. La perforation colique et l’hémorragie digestive en sont les principales complications. La survenue d’un hémopéritoine par rupture d’un hématome sous-capsulaire splénique est une complication extrêmement rare et potentiellement mortelle de la coloscopie. Un traumatisme splénique minime passé inaperçu et la prise d’anticoagulant en sont des facteurs favorisants. Nous présentons le cas d’une rupture d’un hématome sous-capsulaire de la rate après une coloscopie, survenue chez un patient de 70 ans porteur d’une valve mitrale mécanique sous acénocoumarol à dose hypocoagulante. La nécessité d’obtention d’une anticoagulation rapidement efficace et l’instabilité hémodynamique avaient justifié la réalisation d’une splénectomie. L’évolution était favorable. À travers cette observation clinique, nous discutons les mécanismes et les modalités de prise en charge devant cette complication.
Abstract
Nowadays, diagnostic and therapeutic colonoscopy is an invasive medical technique that is commonly practiced. However, the colon perforation and gastrointestinal bleeding are the main complications. The occurrence of hemoperitoneum due to rupture of a subcapsular hematoma of spleen is an extremely rare complication and potentially fatal colonoscopy. Both slightly negligible unnoticed splenic trauma and anticoagulant therapy are causal factors. We present the case of a subcapsular hematoma of spleen after colonoscopy, occurred in a patient of 70 years carrying a mechanical mitral valve treated by acenocoumarol. The requirement of obtaining a rapid and efficient anticoagulation and hemodynamic instability justified the splenectomy. The outcome was favorable. Through this clinical case, we discuss the methods and modalities of care for such a complication.
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Sbai, H., Boukatta, B., El Bouazzaoui, A. et al. Complication rare de la coloscopie chez un patient sous anticoagulant : hémopéritoine par rupture d’un hématome sous-capsulaire de la rate. Acta Endosc 42, 304–310 (2012). https://doi.org/10.1007/s10190-012-0289-6
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DOI: https://doi.org/10.1007/s10190-012-0289-6