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Endovascular Treatment of Active Splenic Bleeding After Colonoscopy: A Systematic Review of the Literature

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Abstract

Purpose

Colonoscopy is reported to be a safe procedure that is routinely performed for the diagnosis and treatment of colorectal diseases. Splenic rupture is considered to be a rare complication with high mortality and morbidity that requires immediate diagnosis and management. Nonoperative management (NOM), surgical treatment (ST), and, more recently, proximal splenic artery embolization (PSAE) have been proposed as treatment options. The goal of this study was to assess whether PSAE is safe even in high-grade ruptures.

Methods

We report two rare cases of post colonoscopy splenic rupture. A systematic review of the literature from 2002 to 2010 (first reported case of PSAE) was performed and the three types of treatment compared.

Results

All patients reviewed (77 of 77) presented with intraperitoneal hemorrhage due to isolated splenic trauma. Splenic rupture was high-grade in most patients when grading was possible. Six of 77 patients (7.8 %) were treated with PSAE, including the 2 cases reported herein. Fifty-seven patients (74 %) underwent ST. NOM was attempted first in 25 patients with a high failure rate (11 of 25 [44 %]) and requiring a salvage procedure, such as PSAE or ST. Previous surgery (31 of 59 patients), adhesions (10 of 13), diagnostic colonoscopies (49 of 71), previous biopsies or polypectomies (31 of 57) and female sex (56 of 77) were identified as risk factors. In contrast, splenomegaly (0 of 77 patients), medications that increase the risk of bleeding (13 of 30) and difficult colonoscopies (16 of 51) were not identified as risk factors. PSAE was safe and effective even in elderly patients with comorbidities and those taking medications that increase the risk of bleeding, and the length of the hospital stay was similar to that after ST.

Conclusion

We propose a treatment algorithm based on clinical and radiological criteria. Because of the high failure rate after NOM, PSAE should be the treatment of choice to manage grade I through IV splenic ruptures after colonoscopy in hemodynamically stabilized patients.

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Conflict of interest

All the authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Département de Médecine Interne, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

    Antonella Corcillo

  2. Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

    Steve Aellen, Tobias Zingg & Nicolas Demartines

  3. Département de Radiologie Interventionnelle, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

    Pierre Bize & Alban Denys

  4. Service de Chirurgie Viscérale, Thoracique et Vasculaire, Centre Hospitalier du Centre du Valais (CHCVs), Av. du Grand-Champsec 80, CP 736, 1951, Sion, Switzerland

    Steve Aellen

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  1. Antonella Corcillo
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  2. Steve Aellen
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  3. Tobias Zingg
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  4. Pierre Bize
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Corresponding author

Correspondence to Antonella Corcillo.

Additional information

Antonella Corcillo and Steve Aellen contributed equally to this study.

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Corcillo, A., Aellen, S., Zingg, T. et al. Endovascular Treatment of Active Splenic Bleeding After Colonoscopy: A Systematic Review of the Literature. Cardiovasc Intervent Radiol 36, 1270–1279 (2013). https://doi.org/10.1007/s00270-012-0539-1

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  • DOI: https://doi.org/10.1007/s00270-012-0539-1

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