Splenic Rupture After Colonoscopy

A 86-year-old man with no previous surgery presented with very severe pain in the lower abdomen and left shoulder as well as hypotension (105/51 mm Hg). Eight days earlier, an uneventful 19-minute follow-up colonoscopy had been performed during which the instrument could be advanced easily through the left flexure up to the ileum. As residual lesions after unspecific colitis, fissural scaring was present in the distal transverse colon and sigmoid colon. The diagnosis of splenic rupture with hematoperitoneum suspected based on ultrasound findings was confirmed by an abdominal CT scan without any indication of other causes. Due to a catecholamine administration-requiring intraoperative hemorrhagic shock associated with a significant drop in hemoglobin levels (11.3 to 4.7 g/dLl [normal range: 13.7–17.3]), a conventional splenectomy with peritoneal lavage and drainage as well as cell saver autotransfusion and transfusion of red blood cell concentrates was performed instead of the planned laparoscopic procedure. The postoperative clinical course was uneventful and the patient was discharged on day five after surgery. Splenic injury is a rare but potentially lethal complication of colonoscopy (0.020–0.034% of examination), manifesting within 24 hours to 10 days after the intervention. Risk factors include examiner-related factors, such as excessive traction on the splenocolic ligament, and patient-related factors, such as preexisting splenocolic adhesions. A history of previous surgical procedures should therefore always be obtained and documented.

Figure

Contrast abdominal computed tomography scan

Prof. Dr. med. Karsten Müssig, Klinik für Innere Medizin, Gastroenterologie und Diabetologie, Niels-Stensen-Kliniken, Franziskus-Hospital Harderberg, Georgsmarienhütte, [e-mail]

Dr. med. Otfried Sauer, Klinik für Radiologie, Niels-Stensen-Kliniken, Franziskus-Hospital Harderberg, Georgsmarienhütte

Dr. med. Petr Ziegler, Klinik für Allgemein- und Viszeralchirurgie, Niels-Stensen-Kliniken, Franziskus-Hospital Harderberg, Georgsmarienhütte

Conflict of interest: The authors declare no conflict of interest.

Translated from the original German by Ralf Thoene, MD.

Cite this as: Müssig K, Sauer O, Ziegler P: Splenic rupture after colonoscopy. Dtsch Arztebl Int 2024; 121: 654a. DOI: 10.3238/arztebl.m2024.0041