Presentation
Persistent hypotension with generalized abdominal pain following colonoscopy earlier that day.
Patient Data
A large hemoperitoneum associated with a laminated perisplenic hematoma is present with evidence of contrast media blush indicating active bleeding.
A surgical clip is demonstrated in the region of the sigmoid colon. Diverticulosis of the sigmoid colon is also present without evidence of diverticulitis.
Case Discussion
The patient underwent urgent splenectomy and was later discharged from hospital.
Splenic injury associated with colonoscopy is a rare occurrence. The suggested mechanism of injury has been described as mechanical tension on the splenocolic ligament or adhesions following previous surgery 1. Risk factors include hematological, infectious and infiltrative diseases that cause splenomegaly, as well as pancreatitis, and inflammatory bowel disease 2.
Other causes of iatrogenic splenic injury include endoscopic retrograde cholangiopancreatography (ERCP), nephrectomy, cardiopulmonary resuscitation, percutaneous nephrolithotomy (PCNL), lung biopsy, chest drain, and even rarely spinal surgery 3.
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