SPLENIC RUPTURE FOLLOWING COLONOSCOPY: A CASE REPORT

Objectives: Introduction/Objective
Splenic rupture following colonoscopy (SRFC) is a rare, but potentially fatal, complication with an estimated incidence of 0.00005-0.017% and a mortality rate of 5%. There have been less than 200 cases reported with most of them being managed operatively. We present a patient who underwent successful conservative management of SRFC.
Case Presentation
The patient is a 75-year-old female who presented to an outside hospital with a syncopal episode and abdominal pain eight hours after a routine colonoscopy. Her colonoscopy was notable only for tortuous colon. Her vitals on presentation were: pulse 76, blood-pressure 106/64, respiratory-rate 18, and oxygen-saturations 98%. Her abdomen was soft, nondistended, and mildly tender to palpation in left upper quadrant with no guarding. Diagnostic work-up showed hemoglobin 7.6 and hemoperitoneum with grade three splenic trauma in CT abdomen and pelvis with intravenous contrast. She was transfused one-unit packed red blood cells (PRBC) and transferred to our facility.
Upon arrival, she was hemodynamically stable with abdominal exam unchanged. On hospital-day (HD) 2, her hemoglobin downtrended to 6.8 with stable hemodynamics. She was transfused one-unit PRBC, and CT angiography of abdomen was stable with no extravasation. We continued with conservative management. During her hospital stay, she required one additional PRBC transfusion. She was discharged on HD6 following an uneventful course and was doing well during follow-up.
Discussion
SRFC often occurs in uncomplicated, easy colonoscopies and in patients with no apparent risk factors. Direct trauma to the spleen, traction on the splenocolic ligament, and traction on the splenocolic adhesions are the three postulates in the literature to explain SRFC.
Conclusion
Splenic rupture should be considered in patient who presents with abdominal pain, syncope, and hypotension following colonoscopy. Management guidelines for splenic trauma should be followed once recognized. Management decision regarding operative vs conservative should be guided by patient’s clinical status, hemodynamics, and available resources.

Methods:

Results:

Conclusion: