Abstract
Introduction
Colonoscopy is a safe procedure that is performed routinely worldwide. There is, however, a small but significant risk of splenic injury that is often under-recognized. Due to a lack of awareness about this injury, the diagnosis may be delayed, which can lead to an increased risk of morbidity as well as mortality. This paper presents a comprehensive review of the medical literature on colonoscopy-associated splenic injury and describes the clinical presentation and management of this rare but potentially life-threatening complication.
Materials and Methods
A comprehensive literature search identified 102 patients worldwide, including patients from our experience, with splenic injury during colonoscopy. A meta-regression analysis was completed using a mixed generalized linear model for repeated measures to identify risk factors for this rare complication.
Results
A total of 75 articles were identified and 102 patients were studied. The majority of the papers were in English (92 %). Only 23.4 % of patients (26/102) were reported prior to the year 2000. Among the patients reported after the year 2000, the majority (84.2 %, 64/76) were reported after 2005. There were more females (76.5 %), median age was 65 years (range, 29–90 years), and most of the colonoscopies were performed without difficulty (66.6 %). Nearly 67 % of patients presented within 24 h of colonoscopy with complaints ranging from abdominal pain to dizziness. The most common symptom was left upper quadrant pain (58 %), and CT scan was found to be the most sensitive tool for diagnosis. Seventy-three patients underwent operative intervention; 96 % of these were treated with splenectomy. Hemoglobin drop of more than 3 gm/dL was identified as the only significant predictor of operative intervention. The overall mortality rate was 5 %.
Conclusion
Splenic injury during colonoscopy is rare; however, it is associated with significant morbidity and mortality. Splenic injury warrants a high degree of clinical suspicion critical to prompt diagnosis, and early surgical consultation is warranted.
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References
Seeff LC, Richards TB, Shapiro JA, Nadel MR, Manninen DL, Given LS, Dong FB, Winges LD, McKenna MT. How many endoscopies are performed for colorectal cancer screening? Results from CDC’s survey of endoscopic capacity. Gastroenterology 2004;127:1670 –1677.
Macrae FA, Tan KG, Williams CB. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut 1983;24:376–383.
Ha JF, Minchin D. Splenic injury in colonoscopy: a review. Int J Surg 2009;7(5):424–427.
Wherry DC, Zehner H Jr. Colonoscopy–fiberoptic endoscopic approach to the colon and polypectomy. Med Ann Dist Columbia. 1974;43(4):189–192.
Smith LE. Fiberoptic colonoscopy: complications of colonoscopy and polypectomy. Dis Colon Rectum 1976;19(5):407–412
Ong E, Bohmler U, Wurbs D. Splenic injury as a complication of endoscopy: two case reports and a literature review. Endoscopy 1991;23:302–304.
Jentschura D, Raute M, Winter J, Henkel T, Kraus M, Manegold BC. Complications in endoscopy of the lower gastrointestinal tract. Therapy and prognosis. Surg Endosc 1994;8:672–676.
Lieberman DA, De Garmo PL, Fleischer DE, Eisen GM, Helfand M. Patterns of endoscopy use in the United States. Gastroenterology 2000;118(3):619–624.
Wilkins T, LeClair B, Smolkin M, Davies K, Thomas A, Taylor ML, Strayer S. Screening colonoscopies by primary care physicians: a meta-analysis. Ann Fam Med 2009;7(1):56–62.
Sonnenberg A, Amorosi SL, Lacey MJ, Lieberman DA. Patterns of endoscopy in the United States: analysis of data from the Centers for Medicare and Medicaid Services and the National Endoscopic Database. Gastrointest Endosc 2008;67(3):489–496.
Ahmed A, Eller PM, Schiffman FJ. Splenic rupture: an unusual complication of colonoscopy. Am J Gastroenterol 1997;92(7):1201–1204.
Taylor FC, Frankl HD, Riemer KD. Late presentation of splenic trauma after routine colonoscopy. Am J Gastroenterol 1989;84:442–443.
Tse CC, Chung KM, Hwang JS. Splenic injury following colonoscopy. Hong Kong Med J 1999;5(2):202–203.
Rozycki GS, Ballard RB, Feliciano DV, Schmidt JA, Pennington SD. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg 1998;228:557–567.
Moore EE, Cogbill TH, Jurkovich MD, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1995;38:323.
Boscak A, Shanmuganathan K. Splenic trauma: what is new? Radiol Clin North Am 2012;50(1):105–22.
Telmos AJ, Mittal VK. Splenic rupture following colonoscopy. JAMA 1977;237(25):2718.
Ellis WR, Harrison JM, Williams RS. Rupture of spleen at colonoscopy. Br Med J 1979;1(6159):307–308.
Kloer H, Schmidt-Wilcke HA, Schulz U. Splenic rupture as a consequence of colonoscopy. Dtsch Med Wochenschr 1984;109(46):1782–1783.
Castelli M. Splenic rupture: an unusual late complication of colonoscopy. CMAJ 1986;134(8):916–917.
Reynolds FS, Moss LK, Majeski JA, Lamar C Jr. Splenic rupture following colonoscopy. Gastrointest Endosc 1986;32(4):307–308.
Doctor NM, Monteleone F, Zarmakoupis C, Khalife M. Splenic injury as a complication of colonoscopy and polypectomy. Report of a case and review of the literature. Dis Colon Rectum 1987;30(12):967–968.
Levine E, Wetzel LH. Splenic trauma during colonoscopy. AJR Am J Roentgenol 1987;149(5):939–940.
Tuso P, McElligott J, Marignani P. Splenic rupture at colonoscopy. J Clin Gastroenterol 1987;9(5):559–562.
Gores PF, Simso LA. Splenic injury during colonoscopy. Arch Surg 1989; 124(11):1342.
Rockey DC, Weber JR, Wright TL, Wall SD. Splenic injury following colonoscopy. Gastrointest Endosc 1990;36(3):306–309.
Colarian J, Alousi M, Calzada R. Splenic trauma during colonoscopy. Endoscopy 1991;23(1):48–49.
Viamonte M, Wulkan M, Irani H. Splenic trauma as a complication of colonoscopy. Surg Laparosc Endosc 1992;2(2):154–157.
Dodds LJ, Hensman C. Splenic trauma following colonoscopy. Aust N Z J Surg 1993;63(11):905–906.
Heath B, Rogers A, Taylor A, Lavergne J. Splenic rupture: an unusual complication of colonoscopy. Am J Gastroenterol 1994;89(3):449–450.
Coughlin F, Aanning HL. Delayed presentation of splenic trauma following colonoscopy. S D J Med 1997;50(9):325–326.
Espinal EA, Hoak T, Porter JA, Slezak FA. Splenic rupture from colonoscopy. A report of two cases and review of the literature. Surg Endosc 1997;11(1):71–73.
Moses RE, Leskowitz SC. Splenic rupture after colonoscopy. J Clin Gastroenterol 1997;24(4):257–258.
Olshaker JS, Deckleman C. Delayed presentation of splenic rupture after colonoscopy. J Emerg Med 1999;17(3):455–457.
Reissman P, Durst AL. Splenic hematoma. A rare complication of colonoscopy. Surg Endosc 1998;12(2):154–155.
Melsom DS, Cawthorn SJ. Splenic injury following routine colonoscopy. Hosp Med 1999;60(1):65.
Stein DF, Myaing M, Guillaume C. Splenic rupture after colonoscopy treated by splenic artery embolization. Gastrointest Endosc 2002;55(7):946–948.
Hamzi L, Soyer P, Boudiaf M, Najmeh N, Abitbol M, Dahan H, Rymer R. Splenic rupture following colonoscopy: report of an unusual case in the absence of underlying splenic disease. J Radiol 2003;84(3):320–322.
Rinzivillo C, Minutolo V, Gagliano G, Minutolo G, Morello A, Scilletta B, Li Destri G. Splenic trauma following colonoscopy. G Chir 2003;24(8–9):309–311.
Al Alawi I, Gourlay R. Rare complication of colonoscopy. ANZ J Surg 2004; 74(7):605–606.
Boghossian T, Carter JW. Early presentation of splenic injury after colonoscopy. Can J Surg 2004;47(2):148.
Goitein D, Goitein O, Pikarski A. Splenic rupture after colonoscopy. Isr Med Assoc J 2004;6(1):61–62.
Holzer K, Thalhammer A, Bechstein WO. Splenic trauma—a rare complication during colonoscopy. Z Gastroenterol 2004;42(6):509–512.
Jaboury I. Splenic rupture after colonoscopy. Intern Med J 2004;34(11):652–653.
Lekas BJ. Splenic hematoma as a complication of colonoscopy. J Am Geriatr Soc 2004;52(2):320–321.
Prowda JC, Trevisan SG, Lev-Toaff AS. Splenic injury after colonoscopy: conservative management using CT. AJR Am J Roentgenol 2005;185(3):708–710.
Janes SE, Cowan IA, Dijkstra B. A life threatening complication after colonoscopy. BMJ 2005;330(7496):889–890.
Naini MA, Masoompour SM. Splenic rupture as a complication of colonoscopy. Indian J Gastroenterol 2005;24(6):264–265.
Pfefferkorn U, Hamel CT, Viehl CT, et al. Haemorrhagic shock caused by splenic rupture following routine colonoscopy. Int J Colorectal Dis 2007; 22(5):559–560.
Shah PR, Raman S, Haray PN. Splenic rupture following colonoscopy: rare in the UK? Surgeon 2005;3(4):293–295.
Weisgerber K, Lutz MP. Splenic rupture after colonoscopy. Clin Gastroenterol Hepatol 2005;3(11):A24.
Johnson C, Mader M, Edwards DM, Vesy T. Splenic rupture following colonoscopy: two cases with CT findings. Emerg Radiol 2006;13(1):47–49.
Luebke T, Baldus SE, Holscher AH, Monig SP. Splenic rupture: an unusual complication of colonoscopy: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 2006;16(5):351–354.
Shatz DV, Rivas LA, Doherty JC. Management options of colonoscopic splenic injury. JSLS 2006;10(2):239–243.
Volchok J, Cohn M. Rare complications following colonoscopy: case reports of splenic rupture and appendicitis. JSLS 2006;10(1):114–116.
Zenooz NA, Win T. Splenic rupture after diagnostic colonoscopy: a case report. Emerg Radiol 2006;12(6):272–273.
Di Lecce F, Viganò P, Pilati S, Mantovani N, Togliani T, Pulica C. Splenic rupture after colonoscopy. A case report and review of the literature. Chir Ital 2007;59(5):755–757.
Dugué L, Maftouh A, Condat B, Zanditenas D, Bonnet J, Balian C, Loriferne JF, Blazquez M, Charlier A. Rare complication of colonoscopy: hemoperitoneum secondary to splenic rupture. Gastroenterol Clin Biol 2007;31(12):1153–1154.
Holubar S, Dwivedi A, Eisdorfer J, Levine R, Strauss R. Splenic rupture: an unusual complication of colonoscopy. Am Surg 2007;73(4):393–396.
Lalor PF, Mann BD. Splenic rupture after colonoscopy. JSLS 2007;11(1):151–156.
Petersen CR, Adamsen S, Gocht-Jensen P, Arnesen RB, Hart-Hansen O. Splenic injury after colonoscopy. Endoscopy 2008;40(1):76–79.
Tsoraides SS, Gupta SK, Estes NC. Splenic rupture after colonoscopy: case report and literature review. J Trauma 2007;62(1):255–257.
Duarte CG. Splenic rupture after colonoscopy. Am J Emerg Med 2008;26(1):117.e1-3.
Famularo G, Minisola G, De Simone C. Rupture of the spleen after colonoscopy: a life-threatening complication. Am J Emerg Med 2008;26(7):834.e3-4.
Guerra JF, San Francisco I, Pimentel F, Ibanez L. Splenic rupture following colonoscopy. World J Gastroenterol 2008;14(41):6410–6412.
Movva A, Marek S, Raina D, Sridhar S. Delayed diagnosis of splenic hematoma after routine colonoscopy. Am J Gastroenterol 2008;103(S1):S229.
Parker WT, Edwards MA, Bittner JG 4th, Mellinger JD. Splenic hemorrhage: an unexpected complication after colonoscopy. Am Surg 2008;74(5):450–452.
Pichon N, Mathonnet M, Verdière F, Carrier P. Splenic trauma: an unusual complication of colonoscopy with polypectomy. Gastroenterol Clin Biol 2008; 32(2):123–127.
Rumstadt B, Schilling D, Sturm J. The role of laparoscopy in the treatment of complications after colonoscopy. Surg Laparosc Endosc Percutan Tech 2008;18(6):561–564.
Schilling D, Kirr H, Mairhofer C, Rumstadt B. Splenic rupture after colonoscopy. Dtsch Med Wochenschr 2008;133(16):833–835.
Saad A, Rex DK. Colonoscopy-induced splenic injury: report of 3 cases and literature review. Dig Dis Sci 2008;53(4):892–898.
de Vries J, Ronnen HR, Oomen AP, Linskens RK. Splenic rupture following colonoscopy, a rare complication. Neth J Med 2009;67(6):230–233.
Kamath AS, Iqbal CW, Sarr MG, Cullinane DC, Zietlow SP, Farley DR, Sawyer MD. Colonoscopic splenic injuries: incidence and management. J Gastrointest Surg 2009;13(12):2136–2140.
Kiosoglous AJ, Varghese R, Memon MA. Splenic rupture after colonoscopy: a case report. Surg Laparosc Endosc Percutan Tech 2009;19(3):e104-105.
Platt A, Fuhrman M. Immediate presentation of splenic hematoma following colonoscopy. Am J Gastroenterol 2009;104(S3):S372.
Ranganath R, Selinger S. An uncommon complication of a common procedure. Postgrad Med J 2009;85(1002):224.
Sarhan M, Ramcharan A, Ponnapalli S. Splenic injury after elective colonoscopy. JSLS 2009;13(4):616–619.
Skipworth JR, Raptis DA, Rawal JS, Olde Damink S, Shankar A, Malago M, Imber C. Splenic injury following colonoscopy—an underdiagnosed, but soon to increase, phenomenon? Ann R Coll Surg Engl 2009; 91(4):W6-11.
Desai B. Splenic laceration following routine colonoscopy. South Med J 2010; 103(11):1181–1183.
DuCoin C, Acholonu E, Ukleja A, Cellini F, Court I, Dabage N, Szomstein S, Rosenthal RJ. Splenic rupture after screening colonoscopy: case report and literature review. Surg Laparosc Endosc Percutan Tech 2010;20(1):e31-33.
Hutchinson B, Heeney A, Conneely J, Traynor O. Splenic laceration following colonoscopy. Ir J Med Sci 2010;179(4):633–634.
Meier RP, Toso C, Volonte F, Mentha G. Splenic rupture after colonoscopy. Am J Emerg Med 2011;29(2):241.e1-2.
Pothula A, Lampert J, Mazeh H, Eisenberg D, Shen HY. Splenic rupture as a complication of colonoscopy: report of a case. Surg Today 2010;40(1):68–71.
Randriamarolahy A, Cucchi JM, Brunner P, Garnier G, Demarquay JF, Bruneton JN. Two rare cases of spontaneous splenic rupture. Clin Imaging 2010;34(4):306–308.
Theodoropoulos J, Krecioch P, Myrick S, Atkins R. Delayed presentation of a splenic injury after colonoscopy: a diagnostic challenge. Int J Colorectal Dis 2010;25(8):1033–1034.
Rasul T, Leung E, McArdle K, Pathak R, Dalmia S. Splenic rupture following routine colonoscopy. Dig Endosc 2010;22(4):351–353.
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Singla, S., Keller, D., Thirunavukarasu, P. et al. Splenic Injury During Colonoscopy—a Complication that Warrants Urgent Attention. J Gastrointest Surg 16, 1225–1234 (2012). https://doi.org/10.1007/s11605-012-1871-0
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DOI: https://doi.org/10.1007/s11605-012-1871-0