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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 6/2012

01-06-2012 | Original Article

Splenic Injury During Colonoscopy—a Complication that Warrants Urgent Attention

Authors: S. Singla, D. Keller, P. Thirunavukarasu, D. Tamandl, S. Gupta, J. Gaughan, D. Dempsey

Published in: Journal of Gastrointestinal Surgery | Issue 6/2012

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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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Metadata
Title
Splenic Injury During Colonoscopy—a Complication that Warrants Urgent Attention
Authors
S. Singla
D. Keller
P. Thirunavukarasu
D. Tamandl
S. Gupta
J. Gaughan
D. Dempsey
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 6/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-012-1871-0

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