Splenic rupture secondary of colonoscopy

González-Andrades, Elena

doi:10.1016/j.medcle.2020.12.032

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Although it is a routine procedure, it is not free of potential complications, so it is necessary to be aware of the possible risks associated with the use of this technique<a class="elsevierStyleCrossRef" href="#bib0005">1</a>.We report a case of splenic rupture after performing a colonoscopy.A 62-year-old woman with a history of total hysterectomy and appendectomy, who came to the hospital where the colonoscopy was performed for prevention and follow-up of colonic diverticulosis the same afternoon of the intervention, complaining of severe abdominal pain. An enema was administered with improvement of symptoms. 24 hours later, she came to our emergency department for severe stomach cramp, predominantly in the left hemiabdomen, which was accompanied by a worsening of the general condition.While history-taking and examination of the patient was completed, she asked to go to the bathroom, where she suffered syncopal symptoms with hypotension, for which she was transferred to the critical care ward, where a peripheral line was inserted and an abdominal X-ray was performed, in which a non-specific airway pattern was observed with no signs of obstruction. Given the persistence of pain, anaemia and general malaise, it was decided to perform an abdominal CT scan without contrast (due to the patient's allergy to it) in which haemoperitoneum and an enlarged, heterogeneous and unstructured spleen were observed, suggestive of splenic trauma.The patient was assessed by the general surgery department, and it was decided to perform an emergency laparotomy with total splenectomy, finding a large haemoperitoneum.The patient was discharged 12 days after admission, following a satisfactory postoperative period.The most common complications derived from performing colonoscopies include bleeding (1%) and perforation (0.1-0.2%). Splenic rupture is rarely reported in the scientific literature, with 72 reports worldwide since 1974<a class="elsevierStyleCrossRef" href="#bib0010">2</a>, when the first case was described, and is one of the most serious complications of colonoscopy.As for the aetiopathogenesis, 3 theories are postulated: direct trauma of the endoscope passing through the splenic angle, excessive traction on the splenocolic ligament and, what seems to be the main one, excessive traction of adhesions between the spleen and the colon in patients who have undergone previous abdominal surgery<a class="elsevierStyleCrossRef" href="#bib0015">3</a>.Symptoms usually occur within 24 h, although cases have been reported in the literature where symptoms have occurred even up to 5 days following the colonoscopy<a class="elsevierStyleCrossRef" href="#bib0020">4</a>. The main symptoms are severe abdominal pain, more acute in the left upper quadrant, which may be accompanied by radiation to the left shoulder, the so-called Kehr’s sign, pseudoperitonitis and even hypovolemic shock as the first manifestation<a class="elsevierStyleCrossRef" href="#bib0025">5</a>.In view of the seriousness of this entity, early diagnosis by abdominal X-ray is of vital importance to rule out the presence of pneumoperitoneum, and if symptoms persist, performing the imaging test of choice in this case: Abdominal CT with intravenous contrast, which will allow the visualization of hemoperitoneum, active bleeding and perforation, among others. If abdominal CT is not possible, abdominal ultrasound can be used<a class="elsevierStyleCrossRef" href="#bib0020">4</a>.Treatment will depend primarily on the haemodynamic status of the patient, the extent of the injury and whether or not there is active bleeding. Thus, if the patient is haemodynamically stable, the injury is low grade and there is no active bleeding, conservative treatment with fluid therapy, broad-spectrum antibiotic therapy, blood transfusion and monitoring can be carried out. In some cases of active bleeding, embolization of the splenic artery can be performed, although in this case, as in the case of severe splenic trauma, the treatment of choice is total splenectomy, as in the clinical case described here<a class="elsevierStyleCrossRef" href="#bib0025">5</a>.It is especially important that we take into account the existence of this serious complication, and that in the presence of intense abdominal pain accompanied by anaemia, without evidence of intestinal perforation, a possible splenic trauma should be suspected, as early diagnosis is essential for the survival of patients." 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Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v25.i2.190" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2019" "volumen" => "25" "paginaInicial" => "190" "paginaFinal" => "204" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30670909" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delayed presentation of a splenic injury after colonoscopy: A diagnostic challenge" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Theodoropoulos" 1 => "P. Krecioch" 2 => "S. Myrick" 3 => "R. Atkins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00384-010-0918-5" "Revista" => array:6 [ "tituloSerie" => "Int J Colorectal Dis" "fecha" => "2010" "volumen" => "25" "paginaInicial" => "1033" "paginaFinal" => "1034" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20217421" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Splenic rupture: An unusual complication of colonoscopy: Case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Luebke" 1 => "S.E. Baldus" 2 => "A.H. Holscher" 3 => "S.P. Monig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.sle.0000213703.94687.50" "Revista" => array:6 [ "tituloSerie" => "Surg Laparosc Endosc Percutan Tech" "fecha" => "2006" "volumen" => "16" "paginaInicial" => "351" "paginaFinal" => "354" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17057581" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Splenic rupture after colonoscopy: Report of a case and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Cappellani" 1 => "M. Di Vita" 2 => "A. Zanghì" 3 => "A. Cavallaro" 4 => "G. Alfano" 5 => "G. Piccolo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1749-7922-3-8" "Revista" => array:5 [ "tituloSerie" => "World J Emerg Surg" "fecha" => "2008" "volumen" => "3" "paginaInicial" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18261241" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Splenic Rupture as a Complication of Colonoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Barbeiro" 1 => "C. Atalaia-Martins" 2 => "P. Marcos" 3 => "J. Nobre" 4 => "C. Gonçalves" 5 => "C. Aniceto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000452695" "Revista" => array:6 [ "tituloSerie" => "GE Port J Gastroenterol" "fecha" => "2017" "volumen" => "24" "paginaInicial" => "188" "paginaFinal" => "192" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29255749" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015700000012/v1_202112201710/S2387020621006331/v1_202112201710/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015700000012/v1_202112201710/S2387020621006331/v1_202112201710/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006331?idApp=UINPBA00004N"]

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Vol. 157. Issue 12.

Pages 592-593 (December 2021)

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