S4557 Splenic Laceration Following Routine Colonoscopy: A Rare Complication

Introduction: Colonoscopy is a common and generally safe procedure, but serious complications can occur. Splenic injury after colonoscopy is quite rare with the first case to be reported dating back to 1974. Colonoscopy remains the highest associated procedure that can cause splenic laceration more predominantly occurring in females. We present a rare case of an elderly woman who sustained a splenic laceration with hemoperitoneum after a routine screening colonoscopy. Case Description/Methods: A 75-year-old woman with no significant surgical history underwent a screening colonoscopy which was uneventful. In recovery she developed sudden left sided abdominal tenderness and left shoulder pain. Non contrast computed tomography (CT) imaging revealed splenic haziness hence CT angiogram was obtained which revealed splenic laceration with no active bleeding, however had concealed hemoperitoneum. She was transferred to our hospital for specialty services. Her vitals were stable throughout and no physical signs of peritonitis. Her hemoglobin had a slight drop on day of admission however it stabilized soon. General surgery consultation was obtained who recommended a non-operative approach. Her pain largely subsided and she was discharged with instructions for close follow-up. Subsequent encounter with the patient revealed resolution of the pain and no evidence of infarction on imaging. Discussion: Proposed mechanisms of splenic injury include traction on the splenocolic ligament, rupture of splenocolic adhesions from prior surgery, or direct trauma to the spleen by the endoscope. Deep sedation may contribute by blunting patient feedback to pain during difficult maneuvering. Onset is often within 24–48 hours post-colonoscopy, though delayed presentations up to several days have been documented. The diagnostic test of choice is a contrast-enhanced computed tomography scan, which can sensitively detect splenic injuries and hemoperitoneum. Large or actively bleeding splenic lacerations may require splenic artery embolization or emergency splenectomy. Awareness of this rare complication is crucial, physicians should maintain a high clinical suspicion for splenic injury in any patient who presents with unexplained abdominal pain post colonoscopy. Educating endoscopy staff and explaining the risks prior to procedure lead to better patient-provider relationship. More data aggregation aimed to identify serious adverse events like splenic infarction can help formulate quality indicators after colonoscopy as well as help reduce malpractice claims.