The diversity of splenic injuries post-colonoscopy

Iatrogenic splenic injury can be a life threatening but rarely reported complication post-colonoscopy. Indeed, as the use of colonoscopy has increased, owing to its central role in colorectal cancer surveillance, this complication is under-recognized. Indeed, previous abdominal surgery, anatomic variations between the spleen and splenic flexure and difficulty in negotiating the splenic flexure via looping have been determined as factors possibly contributing to splenic injury following colonoscopy. Its prompt recognition, particularly in the hemodynamically unstable patient, is of vital importance in determining whether to proceed with operative or nonoperative management. Here, we present the cases of a 79-year-old woman who presented to the Emergency Department 8 days post-colonoscopy with a subcapsular splenic hematoma who was managed conservatively, as well as a 67-year-old woman who presented 1-day post-colonoscopy with hemodynamic instability and a Grade V splenic rupture, requiring emergent open splenectomy.