Omar Tageldin, MD1, Hau Chieng, DO2, Lezah McCarthy, MD3, Hala Abdelwahab, MD1, Elise Malecki, MD, PhD4, Kristoffer Neu, MD4 1Albany Medical Center, Albany, NY; 2Albany Medical College, Albany, NY; 3Albany VA Medical Center, Albany, NY; 4Stratton Veteran Affairs Medical Center, Albany, NY
Introduction: Splenic injury after colonoscopy is a rare and underreported complication with undefined mechanism. Patients with underlying splenic pathology or spleno-colic adhesions are at higher risk for injury. We present a case of splenic laceration after colonoscopy that necessitated emergent open splenectomy.
Case Description/Methods: A 61-year-old white male with no prior medical problems including splenic disease presented for an elective screening colonoscopy after a positive fecal immunochemical test. Patient was discharged home after an uneventful colonoscopy which was significant for multiple polyps (sessile and pedunculated) that were removed with hot and cold snares. Patient came back to the emergency room several hours later with the complaints of diffuse abdominal pain, lightheadedness and inability to pass gases or stool. He was tachycardic and hypotensive. His abdomen was distended, rigid and diffusely tender without peritoneal signs. Laboratory showed a hemoglobin of 9.9 g/dl (4 g/dl lower than baseline). An emergent CT scan of abdomen and pelvis without contrast showed splenic laceration with a large amount of free fluid in the pelvis and surrounding the liver [Figure 1]. Patient was taken to the operating room emergently for the concern of splenic rupture. A shattered and decapsulated spleen was excised [Figure 2] along with evacuation of 2.4L of blood with clots. He received 3 units of PRBCs and 1 unit of FFP. Histopathology of the spleen was benign. Patient was observed in the intensive care unit for 4 days without any need for vasopressors. He received a pneumococcal vaccine and discharged home on postoperative day #7.
Discussion: Splenic injury is a very rare but serious complication after colonoscopy with a reported incidence of 0.001% and an overall mortality rate of 5%. Risk factors include underlying splenic disease or previous intrabdominal surgery. Proposed mechanisms in the literature include traction of spleno-colic ligament with torquing of the scope, direct blunt trauma while advancing the scope, or excess external pressure on left hypochondrium. The most common presentation is abdominal pain. Our patient did not have any risk factors and his colonoscopy was uneventful. Clinicians should be aware of this rare and potentially fatal complication. A high index of suspicion for splenic laceration should be maintained in patients complaining of abdominal pain within the first 24 hours after colonoscopy. Expedited imaging and surgical consultation may be necessary when suspected.
Figure: CT scan of abdomen and pelvis (left) and gross image of the spleen (right).
Omar Tageldin indicated no relevant financial relationships.
Hau Chieng indicated no relevant financial relationships.
Lezah McCarthy indicated no relevant financial relationships.
Hala Abdelwahab indicated no relevant financial relationships.
Elise Malecki indicated no relevant financial relationships.
Kristoffer Neu indicated no relevant financial relationships.
Omar Tageldin, MD1, Hau Chieng, DO2, Lezah McCarthy, MD3, Hala Abdelwahab, MD1, Elise Malecki, MD, PhD4, Kristoffer Neu, MD4. P2263 - Splenic Laceration With Intra-Abdominal Hemorrhage After Screening Colonoscopy: A Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.