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1
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Koop H, Skupnik C, Schnoor T, Horenkamp-Sonntag D. Splenic injury associated with colonoscopy in hospitalized patients: Incidence, risk factors, management, and outcome. Endosc Int Open 2024; 12:E1453-E1457. [PMID: 39691743 PMCID: PMC11651917 DOI: 10.1055/a-2453-2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 08/16/2024] [Indexed: 12/19/2024] Open
Abstract
Background and study aims The frequency of splenic injuries due to coloscopy is largely unknown. Therefore, the aim of this study was to give estimate the risk for hospitalized patients. Patients and methods Using the administrative database from a health insurance company with more than 10 million insured subjects, patients undergoing inpatient colonoscopy associated with a splenic injury within 2 weeks were retrieved from the administrative records based upon OPS (comparable to International Classification of Procedures in Medicine) and ICD-10 codes. In each case identified (n = 141), the individual course of the hospital stay was reconstructed and analyzed by two experienced physicians. Patients with overt other causes of splenic injuries (e. g. abominal surgery, trauma etc.) were not further evaluated. Results Among 190,927 total colonoscopies over a 5-year period, 27 splenic lesions were most likely solely due to colonoscopy. This accounts for 14.1 splenic injuries per 100,000 colonoscopies or one lesion in 7,071 patients. Afflicted patients were older and more likely to be female than male (risk in females: 1 in 5,324 colonoscopies). Surgical interventions were carried out in 17 cases, predominantly splenectomy (n = 15) whereas 10 events were managed conservatively. Transfusions and requirement for intensive care unit treatment were strong predictors of need for surgery. Most lesions (74%) were diagnosed within 48 hours after colonoscopy. Death occurred in two patients, but less likely directly due to the splenic injury. Conclusions Administrative data analysis suggests that splenic injuries due to colonoscopy are more frequent than previously estimated. Endoscopists should be aware of this rare life-threatening adverse event.
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Affiliation(s)
- Herbert Koop
- Formerly Dept of Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Torsten Schnoor
- Referat Medizinrecht, Medizinischer Dienst Mecklenburg-Vorpommern, Stralsund, Germany
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2
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Ye Y, Yang R, Peng S, Xiang Q, Chen Y, Lü M, Yang W. Splenic rupture following endoscopic mucosal resection: A case report and literature review. Medicine (Baltimore) 2024; 103:e39846. [PMID: 39465725 PMCID: PMC11460871 DOI: 10.1097/md.0000000000039846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Indexed: 10/29/2024] Open
Abstract
RATIONALE This study aims to highlight the rare but severe complication of splenic rupture following colorectal endoscopic mucosal resection (EMR), advocating for increased vigilance during procedures near the splenic flexure. PATIENT CONCERNS We present a case report of a 66-year-old woman who experienced persistent abdominal pain after undergoing EMR for an adenomatous lesion in the distal transverse colon. DIAGNOSES The diagnosis of splenic rupture was established following her symptoms and clinical evaluation. INTERVENTIONS Active conservative management was implemented after diagnosis. OUTCOMES The patient's recovery underscores the importance of prompt diagnosis and careful monitoring. LESSONS Although splenic rupture after EMR is extremely rare, it is a serious and potentially life-threatening complication. When obtaining informed consent, it is important to emphasize not only common complications like bleeding and perforation but also the risk of splenic injury. Physicians should select appropriate instruments and carefully adjust the angle and force of needle insertion, avoiding excessively long needles and vertical insertion. The procedure should be performed gently to minimize the risk of splenic rupture. For lesions near the splenic flexure, if postoperative abdominal pain occurs, regardless of left shoulder pain, splenic rupture should be considered, and a computed tomography scan promptly performed. Postoperatively, physicians should closely monitor vital signs and repeatedly check blood counts and coagulation parameters. Treatment should be tailored to the splenic injury's extent and the patient's overall condition, with immediate surgery if necessary. High-risk patients should be regularly followed up and instructed to monitor for physical changes. Endoscopists should remain vigilant during procedures, fully understanding potential complications, and closely monitoring the patient's condition postoperatively. This vigilance is key to preventing severe complications and ensuring optimal outcomes.
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Affiliation(s)
- Yusong Ye
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Rui Yang
- School of Graduates, Dalian Medical University, Dalian City, Liaoning Province, China
| | - Shicheng Peng
- Department of Gastroenterology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Qilang Xiang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Yuexi Chen
- Department of Gastroenterology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Muhan Lü
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Weixing Yang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
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3
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Ayaki K, Higashiyama M, Oguro T, Ito S, Tanemoto R, Tomioka A, Nishimura H, Yoshidome Y, Tahara H, Narimatsu K, Komoto S, Tomita K, Hokari R. Moderate Splenic Injury Caused by Colonoscopy. Intern Med 2024; 63:379-383. [PMID: 37316275 PMCID: PMC10901702 DOI: 10.2169/internalmedicine.1827-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/27/2023] [Indexed: 06/16/2023] Open
Abstract
Little is known about iatrogenic splenic injury (SI) as an adverse event after colonoscopy. SI is sometimes fatal because of hemorrhaging. We herein report a man who developed SI after colonoscopy. He recovered conservatively. His history of left hydronephrosis and insertion with a maximally stiffened scope were suspected as possible risk factors. Endoscopists should consider the possibility of SI when they encounter patients suffering from left-sided abdominal pain after colonoscopy. Careful interview concerning the medical history and gentle maneuvering around the splenic flexure can help avoid SI.
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Affiliation(s)
- Kana Ayaki
- Department of Internal Medicine, National Defense Medical College, Japan
| | | | - Takuma Oguro
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Suguru Ito
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Rina Tanemoto
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Akira Tomioka
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Hiroyuki Nishimura
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Yuta Yoshidome
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Hiroyuki Tahara
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Shunsuke Komoto
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Kengo Tomita
- Department of Internal Medicine, National Defense Medical College, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Japan
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4
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Lukies M, Clements W. Splenic artery embolisation for splenic injury during colonoscopy: A systematic review. United European Gastroenterol J 2024; 12:44-55. [PMID: 38047383 PMCID: PMC10859723 DOI: 10.1002/ueg2.12498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/21/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Splenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low-grade injuries or with splenectomy for high-grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes of published cases of splenic injury due to colonoscopy treated with splenic artery embolisation. METHODS A systematic review was performed of published articles concerning splenic injury during colonoscopy treated primarily with splenic artery embolisation, splenectomy, or splenorrhaphy from 1977 to 2022. Datapoints included demographics, past surgical history, indication for colonoscopy, delay to diagnosis, treatment, grade of injury, splenic artery embolisation location, splenic preservation (salvage), and mortality. RESULTS The 30 patients treated with splenic artery embolisation were of mean age 65 (SD 9) years and 67% female, with 83% avoiding splenectomy and 6.7% mortality. Splenic artery embolisation was proximal to the splenic hilum in 81%. The 163 patients treated with splenectomy were of mean age 65 (SD 11) years and 66% female, with 5.5% mortality. Three patients treated with splenorrhaphy of median age 60 (range 59-70) years all avoided splenectomy with no mortality. There was no difference in mortality between splenic artery embolisation and splenectomy cohorts (p = 0.81). CONCLUSIONS Splenic artery embolisation is an effective treatment option in splenic injury due to colonoscopy. Given the known benefits of splenic salvage compared to splenectomy, including preserved immune function against encapsulated organisms, low cost, and shorter hospital length of stay, embolisation should be incorporated into treatment pathways for splenic injury due to colonoscopy in suitable patients.
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Affiliation(s)
- Matthew Lukies
- Department of RadiologyAlfred HealthMelbourneVictoriaAustralia
| | - Warren Clements
- Department of RadiologyAlfred HealthMelbourneVictoriaAustralia
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
- National Trauma Research InstituteMelbourneVictoriaAustralia
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5
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Cortés P, Corral JE, Umar S, Bilal M, Brahmbhatt B, Farraye FA, Kroner PT. Splenic injury is an under-recognized adverse event of in-patient colonoscopy: a nationwide analysis. Endosc Int Open 2022; 10:E178-E182. [PMID: 35178335 PMCID: PMC8847061 DOI: 10.1055/a-1672-3733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/17/2021] [Indexed: 11/02/2022] Open
Abstract
Background and study aims Splenic injury (SI) during colonoscopy is an underappreciated adverse event. Our aim was to examine the occurrence and outcomes of patients who developed SI after inpatient colonoscopy using a nationwide dataset. Patients and methods Retrospective, observational study using the National Inpatient Sample (NIS) between 2012 and 2018. All patients with ICD9/10CM procedural codes for colonoscopy with or without SI were included. The primary outcome was the association between SI and inpatient colonoscopy. Secondary outcomes were inpatient morbidity, mortality, resource utilization, splenectomy rates, hospital length of stay and total hospital costs and charges. Comparative analyses were performed between patients with and without SI. Multivariate regression analyses were utilized. Results A total of 2,258,040 of inpatient colonoscopies were included. Of these, 240 had associated SI and 25 patients required splenectomy (10.4 %). The incidence of colonoscopy-associated SI remained relatively stable between 2012 and 2018 (0.033 % versus 0.020 %, respectively). The mean age of patients with and without SI was 63.7 and 64.1 years, respectively. The occurrence of SI was calculated as 10.63 cases per 100,000 inpatient colonoscopies. Patients who had associated SI displayed significantly higher odds of inpatient mortality (aOR: 14.45) and ICU stay (aOR: 10.11) compared to those without SI. Conclusions Splenic injury confers significantly higher odds of inpatient mortality, and resource utilization. The incidence of SI related to colonoscopy remained stable during the study period. Although uncommon, SI should be considered when encountering patients with abdominal pain after colonoscopy.
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Affiliation(s)
- Pedro Cortés
- Division of Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Juan E. Corral
- Division of Gastroenterology and Hepatology, Albuquerque, New Mexico, United States
| | - Shifa Umar
- Division of Gastroenterology and Hepatology, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, Saint Francis Medical Partners, Bartlett, Tennessee, United States
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Francis A. Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, United States
| | - Paul T. Kroner
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, United States
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6
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Rex DK. The Case for High-Quality Colonoscopy Remaining a Premier Colorectal Cancer Screening Strategy in the United States. Gastrointest Endosc Clin N Am 2020; 30:527-540. [PMID: 32439086 DOI: 10.1016/j.giec.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Most colorectal cancer screening in the United States occurs in the opportunistic setting, where screening is initiated by a patient-provider interaction. Colonoscopy provides the longest-interval protection, and high-quality colonoscopy is ideally suited to the opportunistic setting. Both detection and colonoscopic resection have improved as a result of intense scientific investigation. Further improvements in detection are expected with the introduction of artificial intelligence programs into colonoscopy platforms. We may expect recommended intervals or colonoscopy after negative examinations performed by high-quality detectors to expand beyond 10 years. Thus, high-quality colonoscopy remains an excellent approach to colorectal cancer screening in the opportunistic setting.
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Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 North University Boulevard, Suite 4100, Indianapolis, IN 46202, USA.
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7
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Ullah W, Rashid MU, Mehmood A, Zafar Y, Hussain I, Sarvepalli D, Hasan MK. Splenic injuries secondary to colonoscopy: Rare but serious complication. World J Gastrointest Surg 2020; 12:55-67. [PMID: 32128029 PMCID: PMC7044106 DOI: 10.4240/wjgs.v12.i2.55] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/23/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colonoscopy is a safe and routine diagnostic and therapeutic procedure for evaluation of large bowel diseases. Most common procedure related complications include bleeding and perforation but rarely a splenic Injury.
AIM To investigate the reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients
METHODS A structured search on four databases was done and 45 articles with 68 patients were selected. The reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients were identified and analyzed using SPSS.
RESULTS The mean age of the patients was 62.7 years with 64% females. Twenty two percent had a complete splenic rupture with colonoscopy while 63% had subcapsular hematoma, spleen laceration and spleen avulsion. The most common reason for colonoscopy was screening (46%) followed by diagnostic colonoscopy (28%). Eighty seven percent of patients presented with abdominal pain. Patients with spleen rupture mostly required splenectomy (47%), while minor spleen hematomas and lacerations were managed conservatively (38%). Six percent of the patients were managed with proximal splenic artery splenic embolization and 4% were managed with laparoscopic repair. The overall mortality was 10% while 77% had complete recovery. The reason of colonoscopy against presentation specifically, abdominal pain showed no statistical significance P = 0.69. The indication of colonoscopy had no significant impact on incidence of splenic injury (P = 0.89). Majority of the patients (47%) were managed with splenectomy while the rest were managed conservatively (P = 0.04). This association was moderately strong at a cramer’s V test (0.34). The Fisher exact test showed a higher mortality with spleen rupture (P = 0.028).
CONCLUSION Spleen rupture due to colonoscopy is a significant concern and is associated with high mortality. The management of the patients can be individualized based on clinical presentation.
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Affiliation(s)
- Waqas Ullah
- Department of Internal Medicine, Abington Hospital, Abington, PA 19001, United States
| | - Mamoon Ur Rashid
- Department of Internal Medicine, Advent Health Hospital, Orlando, FL 32804, United States
| | - Asif Mehmood
- Department of Internal Medicine, Geisinger Medical Center, Danville, PA 17822, United States
| | - Yousaf Zafar
- Department of Internal Medicine, UMKC, 5100 Rockhill Rd, Kansas City, MO 64110, United States
| | - Ishtiaq Hussain
- Department of Gastroenterology, Cleveland Clinic, Weston, FL 33331, United States
| | - Deepika Sarvepalli
- Department of Internal Medicine, Advent Health Hospital, Orlando, FL 32804, United States
| | - Muhammad Khalid Hasan
- Department of Gastroenterology, Advent Health Hospital, Orlando, FL 32804, United States
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8
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Chow BL, Zia K. Postcolonoscopy splenic rupture: the under-reporting of an unpropitious phenomena? BMJ Case Rep 2019; 12:12/9/e231047. [PMID: 31511266 DOI: 10.1136/bcr-2019-231047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Splenic rupture secondary to colonoscopy is a rare but potentially fatal complication. Given the disparity between the small number of case reports with the incidence reported by some investigators, we contend that the former is not representative of the true extent of this sequela. We present a case report of postcolonoscopy splenic rupture, where the patient had a bizarre initial presentation of chest pain and collapse; and only developed haemodynamic instability and abdominal pain on day 2 postprocedure. Diagnosis was made with a CT scan, and resolution of symptoms was achieved with a splenectomy.
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Affiliation(s)
- Bing Lun Chow
- General Surgery, Belford Hospital, Fort William, Highland, UK.,Anaesthetics and Critical Care, Borders General Hospital, Melrose, Scottish Borders, UK
| | - Khawaja Zia
- General Surgery, Belford Hospital, Fort William, Highland, UK.,General Surgery, Brighton and Sussex University Hospital NHS Trust, Brighton, UK
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9
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Jaboury IA. Re: Colonoscopic blunt splenic injury: a rare but an important complication. ANZ J Surg 2018. [DOI: 10.1111/ans.14674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Bielawska B, Hookey LC, Sutradhar R, Whitehead M, Xu J, Paszat LF, Rabeneck L, Tinmouth J. Anesthesia Assistance in Outpatient Colonoscopy and Risk of Aspiration Pneumonia, Bowel Perforation, and Splenic Injury. Gastroenterology 2018; 154:77-85.e3. [PMID: 28865733 DOI: 10.1053/j.gastro.2017.08.043] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND & AIMS The increase in use of anesthesia assistance (AA) to achieve deep sedation with propofol during colonoscopy has significantly increased colonoscopy costs without evidence for increased quality and with possible harm. We investigated the effects of AA on colonoscopy complications, specifically bowel perforation, aspiration pneumonia, and splenic injury. METHODS In a population-based cohort study using administrative databases, we studied adults in Ontario, Canada undergoing outpatient colonoscopy from 2005 through 2012. Patient, endoscopist, institution, and procedure factors were derived. The primary outcome was bowel perforation, defined using a validated algorithm. Secondary outcomes were splenic injury and aspiration pneumonia. Using a matched propensity score approach, we matched persons who had colonoscopy with AA (1:1) with those who did not. We used logistic regression models under a generalized estimating equations approach to explore the relationship between AA and outcomes. RESULTS Data from 3,059,045 outpatient colonoscopies were analyzed; 862,817 of these included AA. After propensity matching, a cohort of 793,073 patients who had AA and 793,073 without AA was retained for analysis (51% female; 78% were age 50 years or older). Use of AA did not significantly increase risk of perforation (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.84-1.16) or splenic injury (OR, 1.09; 95% CI, 0.62-1.90]. Use of AA was associated with an increased risk of aspiration pneumonia (OR, 1.63; 95% CI, 1.11-2.37). CONCLUSIONS In a population-based cohort study, AA for outpatient colonoscopy was associated with a significantly increased risk of aspiration pneumonia, but not bowel perforation or splenic injury. Endoscopists should warn patients, especially those with respiratory compromise, of this risk.
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Affiliation(s)
- Barbara Bielawska
- Division of Gastroenterology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Lawrence C Hookey
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Marlo Whitehead
- Institute for Clinical Evaluative Sciences, Kingston, Ontario, Canada
| | - Jianfeng Xu
- Institute for Clinical Evaluative Sciences, Kingston, Ontario, Canada
| | | | - Linda Rabeneck
- Prevention & Cancer Control, Cancer Care Ontario, Toronto, Ontario; University of Toronto, Ontario, Canada
| | - Jill Tinmouth
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Prevention & Cancer Control, Cancer Care Ontario, Toronto, Ontario; Department of Medicine, University of Toronto, Ontario, Canada.
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11
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Forsberg A, Hammar U, Ekbom A, Hultcrantz R. A register-based study: adverse events in colonoscopies performed in Sweden 2001-2013. Scand J Gastroenterol 2017; 52:1042-1047. [PMID: 28562115 DOI: 10.1080/00365521.2017.1334812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The rates for colonoscopy-associated adverse events vary considerably worldwide. In Sweden, the figures are known to a limited extent. We assessed the frequency of severe colonoscopy-related adverse events and the impacts of different risk factors, including the use of general anaesthesia. MATERIAL AND METHODS This is a retrospective population-based cohort study of the colonoscopies performed during the years 2001-2013 on adults identified in the Swedish health registers. The rates for bleeding, perforation, splenic injury and 30-day mortality were calculated. Covariates for risks were assessed in a multivariate Poisson regression model. RESULTS There were 593,315 colonoscopies performed on the 426,560 individuals included in the study. The rates for colonoscopy-related bleeding and perforation were 0.17% and 0.11%, respectively. When polypectomy was performed, the rates were 0.53% for bleeding and 0.25% for perforation. There were 31 splenic injuries (1:20,000 colonoscopies) reported. The crude 30-day death rate for colonoscopy was 0.68%. Of those diagnosed with bleeding or perforation, 5.6% and 6.1% were dead within 30 days, respectively. The multivariate RR for perforation when general anaesthesia was employed was 2.65 (p < .001; 95%CI 1.71-4.12). CONCLUSIONS The perforation rate seemed to be relatively high in an international perspective. General anaesthesia was associated with a significantly higher risk for perforation. Splenic injuries were more frequent than expected.
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Affiliation(s)
- Anna Forsberg
- a Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden
| | - Ulf Hammar
- b Department of Biostatistics , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Anders Ekbom
- a Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden
| | - Rolf Hultcrantz
- c Department of Medicine, Division of Gastroenterology , Huddinge Hospital, Karolinska Institutet , Stockholm , Sweden
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12
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Barbeiro S, Atalaia-Martins C, Marcos P, Nobre J, Gonçalves C, Aniceto C. Splenic Rupture as a Complication of Colonoscopy. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 24:188-192. [PMID: 29255749 DOI: 10.1159/000452695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/09/2016] [Indexed: 12/19/2022]
Abstract
Splenic rupture is a rare but serious complication after colonoscopy, with high global mortality (5%). Diagnosis requires a high index of suspicion because presentation can be subtle, nonspecific, and delayed from hours to days and then not easily attributed to a recent endoscopy. Urgent splenectomy is the most common treatment option. A 73-year-old woman was admitted to the emergency department 8 h following a diagnostic colonoscopy. She presented abdominal pain and syncope. The diagnosis of splenic rupture was made and a splenectomy was urgently performed. The patient's postoperative recovery was uneventful. Splenic rupture is a rare complication of colonoscopy which cannot be underestimated in the differential diagnosis of abdominal pain after this procedure. Splenic injuries may occur in apparently uncomplicated, easy colonoscopies performed by experienced endoscopists, with no risk factors identified, as in this case.
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Affiliation(s)
- Sandra Barbeiro
- Department of Gastroenterology, Centro Hospitalar de Leiria/Pombal, Leiria, Portugal
| | | | - Pedro Marcos
- Department of Gastroenterology, Centro Hospitalar de Leiria/Pombal, Leiria, Portugal
| | - João Nobre
- Department of Surgery, Centro Hospitalar de Leiria/Pombal, Leiria, Portugal
| | - Cláudia Gonçalves
- Department of Gastroenterology, Centro Hospitalar de Leiria/Pombal, Leiria, Portugal
| | - Cristina Aniceto
- Department of Surgery, Centro Hospitalar de Leiria/Pombal, Leiria, Portugal
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13
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Lahat E, Nevler A, Batumsky M, Shapiro R, Zmora O, Gutman M. Diagnosis and management of splenic injury following colonoscopy: algorithm and case series. Tech Coloproctol 2016; 20:163-9. [PMID: 26757901 DOI: 10.1007/s10151-015-1422-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/30/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Splenic injury following colonoscopy is a rare yet life-threatening complication. These injuries are often associated with delayed diagnosis and may require invasive intervention. We sought to study the emergent presentation associated with splenic injury post-colonoscopy and to suggest a new treatment algorithm. METHODS Six cases of splenic injury following colonoscopy were collected from three medical centers. Data regarding patient medical history, clinical presentation, laboratory and imaging findings and clinical management were recorded. A systematic PubMed/MEDLINE search was performed. Non-English-language publications and publications dating earlier than 2010 were excluded. An emergency department trauma-based management algorithm was designed according to the identified publications and review of the available trauma literature. RESULTS The mean age was 65.3 years and the male-to-female ratio was 1:5. Five of the cases presented within 24 h of the colonoscopy complaining of severe abdominal pain. Hemodynamic instability was noted in four patients who presented with tachycardia (105-130), hypotension and/or a rapid drop in hemoglobin levels. All of the patients underwent initial resuscitation and a computerized abdominal tomography scan. Four of them required emergent splenectomy. No mortality or major morbidity was reported following the hospitalization. CONCLUSIONS Although very rare, splenic injury during colonoscopy is an acute, severe and possible fatal complication. Patients may present with a rapid clinical deterioration and hemodynamic instability. Physicians should be familiar with the practical management of this surgical emergency and the treatment options available.
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Affiliation(s)
- E Lahat
- Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel
| | - A Nevler
- Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel.
- The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
| | - M Batumsky
- Department of Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - R Shapiro
- Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - O Zmora
- Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel
| | - M Gutman
- Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel
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Tejada AHD, Giménez-Alvira L, Brule EVD, Sánchez-Yuste R, Matallanos P, Blázquez E, Calleja JL, Abreu LE. Severe splenic rupture after colorectal endoscopic submucosal dissection. World J Gastroenterol 2014; 20:9618-9620. [PMID: 25071360 PMCID: PMC4110597 DOI: 10.3748/wjg.v20.i28.9618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/07/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Splenic rupture (SR) after colonoscopy is a very rare but potentially serious complication. Delayed diagnosis is common, and may increase morbidity and mortality associated. There is no clear relation between SR and difficult diagnostic or therapeutic procedures, but it has been suggested that loop formation and excessive torquing might be risk factors. This is a case of a 65-year-old woman who underwent endoscopic submucosal dissection (ESD) for lateral spreading tumor in the descending colon, and 36 h afterwards presented symptoms and signs of severe hypotension due to SR. Standard splenectomy was completed and the patient recovered uneventfully. Colorectal ESD is usually a long and position-demanding technique, implying torquing and loop formation. To our knowledge this is the first case of SR after colorectal ESD reported in the literature. Endoscopists performing colorectal ESD in the left colon must be aware of this potential complication.
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