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Journal of Gastrointestinal Surgery

, Volume 16, Issue 6, pp 1225–1234 | Cite as

Splenic Injury During Colonoscopy—a Complication that Warrants Urgent Attention

  • S. SinglaEmail author
  • D. Keller
  • P. Thirunavukarasu
  • D. Tamandl
  • S. Gupta
  • J. Gaughan
  • D. Dempsey
Original Article

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.

Keywords

Spleen injury Splenectomy Colonoscopy 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • S. Singla
    • 1
    Email author
  • D. Keller
    • 1
  • P. Thirunavukarasu
    • 3
  • D. Tamandl
    • 4
  • S. Gupta
    • 5
  • J. Gaughan
    • 2
  • D. Dempsey
    • 6
  1. 1.Department of SurgeryTemple University HospitalPhiladelphiaUSA
  2. 2.Department of PhysiologyTemple University HospitalPhiladelphiaUSA
  3. 3.Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  4. 4.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  5. 5.Bharati Vidyapeeth Deemed UniversityPuneIndia
  6. 6.Department of SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA

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