Splenic injuries secondary to colonoscopy: Rare but serious complication

Table 1 Details of case reports and Clavein-Dindo Classification of Post-Operative complication (computed tomography)

Ref.	Age	Sex	Reason for colonoscopy	Type of injury	Diagnosis	Management	Clavein-Dindo classification of Post-Operative complication
Keeven et al[7]	52	Male	Screening	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Suliman et al[8]	59	Female	Screening	Splenic injury/hematoma	CT	Conservative management	Grade I
Diéguez Castillo et al[9]	53	Female	Bleeding	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Zhang et al[11]	63	Female	Weight Loss	Splenic injury/hematoma	CT	Conservative management	Grade I
Chime et al[12]	51	Female	Screening	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Ungprasert et al[13]	59	Male	Screening	Splenic injury/hematoma	CT	Conservative management	Grade I
Laiz Díez et al[14]	40	Female	Screening	Splenic injury/hematoma	CT	Conservative management	Grade I
Laiz Díez et al[14]	80	Female	Screening	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Barbeiro et al[15]	73	Female	Bleeding	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Li et al[16]	65	Female	Screening	Splenic injury/hematoma	CT	Conservative management	Grade I
Nallayici et al[17]	71	Male	Screening	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Pavlidis et al[19]	74	Male	Screening	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Steele et al[20]	60	Female	Screening	Splenic rupture	CT	Conservative management	Grade I
Ozogul et al[21]	69	Female	Polypectomy	Splenic injury/hematoma	CT	Conservative management	Grade I
Mccarty et al[24]	71	Male	Bleeding	Splenic injury/hematoma	CT	Conservative management	Grade I
Jehangir et al[22]	76	Female	Bleeding	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Zappa et al[26]	73	Male	Abdominal pain	Splenic injury/hematoma	CT	Laparotomy/ splenectomy	Grade III
Lahat et al[4]	61	Male	Screening	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Lahat et al[4]	68	Male	Screening	Splenic injury/hematoma	CT	Conservative management	Grade I
Lahat et al[4]	85	Female	Polypectomy	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Lahat et al[4]	54	Male	Polypectomy	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Lahat et al[4]	65	Male	Screening	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Lahat et al[4]	59	Male	Polypectomy	Splenic injury/hematoma	CT	Laparoscopy	Grade III
Mulkerin et al[27]	NA	NA	Screening	Splenic injury/hematoma	CT	Laparoscopy	Grade III
García García et al[28]	58	Female	Screening	Splenic injury/hematoma	CT	Laparoscopy	Grade III
Sbai et al[29]	70	Male	Bleeding	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Ng et al[31]	63	Female	Screening	Splenic injury/hematoma	CT-Angiogram	Conservative management	Grade I
Mazulis et al[32]	88	Female	Bleeding	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Kapur et al[33]	76	Female	Bleeding	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Han et al[34]	77	Male	Polypectomy	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Brennan et al[38]	75	Female	Screening	Splenic injury/hematoma	CT	Proximal splenic artery embolization	Grade III
Herreros de Tejada et al[39]	65	Female	Submucosal Dissection of tumor	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Lauretta et al[40]	61	Male	Screening	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Jamorabo et al[42]	63	Male	Screening	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Guner et al[44]	53	Male	Abdominal Pain	Splenic injury/hematoma	CT	Bed rest, blood transfusion, observation	Grade II
McBride et al[45]	64	Female	Bleeding	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Rex et al[46]	68	Female	NA	NA	CT	Conservative management	Grade I
Rex et al[46]	52	Female	Polypectomy	Splenic injury/hematoma	CT	Conservative management	Grade I
Rex et al[46]	61	Female	NA	NA	CT	Conservative management	Grade I
Rex et al[46]	58	Female	NA	NA	CT	Conservative management	Grade I
Rex et al[46]	74	Female	NA	NA	CT	Conservative management	Grade I
Rex et al[46]	85	Female	NA	NA	CT	Conservative management	Grade I
Chow et al[47]	84	Female	Bleeding	Splenic injury/hematoma	CT	Fluids/blood/splenic artery embolization	Grade III
Pineda et al[48]	62	Female	Screening	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Corcillo et al[49]	66	Male	Bleeding	Splenic rupture	CT	Proximal splenic artery embolization	Grade III
Corcillo et al[49]	77	Female	Polypectomy	Splenic rupture	CT	Proximal splenic artery embolization	Grade III
Abunnaja et al[50]	62	Female	Screening	Splenic injury/hematoma	CT	Ringers lactate, blood, splenectomy, vaccinations	Grade II
González-Soler et al[51]	67	Male	Screening	Splenic rupture	CT	Laparotomy/splenectomy	Grade III
Seifman et al[52]	41	Female	Screening	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Singla et al[54]	NA	NA	Screening	NA	CT	NA	NA
Shankar et al[56]	47	Female	Bleeding	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Fishback et al[58]	64	Female	Screening	Splenic injury/hematoma	CT	Conservative management	Grade I
Fishback et al[58]	59	Female	Bleeding	Splenic injury/hematoma	CT	Conservative management	Grade I
Fishback et al[58]	55	Female	Bleeding	Splenic injury/hematoma	CT	Laparotomy/ splenectomy	Grade III
Fishback et al[58]	65	Male	Polypectomy	NA	CT	Laparotomy/splenectomy	Grade III
Fishback et al[58]	56	Female	Screening	Splenic injury/hematoma	CT	Conservative management	Grade I
Fishback et al[58]	51	Female	Screening	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Fishback et al[58]	54	Female	Screening	Splenic injury/hematoma	CT	Conservative management	Grade I
Fishback et al[58]	68	Female	Screening	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Fishback et al[58]	84	Female	Bleeding	Splenic injury/hematoma	CT	Conservative management	Grade I
Fishback et al[58]	64	Male	Bleeding	Splenic injury/hematoma	CT	Conservative management	Grade I
Fishback et al[58]	64	Male	Screening	Splenic injury/hematoma	CT	Proximal splenic artery embolization/splenectomy	Grade III
Bertoglio et al[59]	70	Male	Bleeding	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Sachdev et al[61]	68	Female	Bleeding	Splenic injury/hematoma	CT	Laparotomy/splenectomy	Grade III
Meier et al[62]	68	Female	Bleeding	NA	CT	Laparotomy/splenectomy	Grade III

NA: Not available; CT: Computed tomography.

Table 2 Reason for colonoscopy and types of injury

	Frequency	Valid percent	Colonoscopy reason	Frequency	Valid percent
Gender
Male	23	35.9	Screening	31	45.6
Female	41	64.1	Bleeding	19	27.9
Injury			Polypectomy	9	13.2
Rupture	15	22	Abdominal pain	2	2.9
Injury	43	63.2	Weight loss	1	1.5

Table 3 Presentation, diagnosis and management of splenic injury

Presentation			Diagnosis and outcome			Management
	Female	Percent (%)		Female	Percent (%)		Female	Percent (%)
Abdominal pain	59	87	CT	67	98.5	Laparotomy	32	47.1
Syncope	4	6	CTPA	1	1.5	PSAE	4	5.9
Dizziness	3	5	Survived	52	76.5	Conservative	26	38.2
Chest pain	1	1.5	Died	7	10.3	Laparoscopy	3	4.4

CTPA: Computed tomography pulmonary angiography; CT: Computed tomography; PSAE: Proximal splenic artery splenic embolization.

Table 4 Likelihood ratios for different comparisons

Comparison	Value	df	P value
Abdominal pain and colonoscopy	2.20	4	0.69
Spleen Injury and colonoscopy	2.37	4	0.66
Splenectomy and colonoscopy	6.4	12	0.89
Splenorrhaphy and colonoscopy	6.8	12	0.91
Outcome and screening colonoscopy	3.17	4	0.52
Outcome and diagnostic colonoscopy	3.21	4	0.61

df: Degree of freedom.

Table 5 Likelihood ratios and Fisher’s test for different comparisons

Comparison	Value	df	P value
Splenectomy and spleen rupture (Likelihood ratio)	8.1	3	0.04
Mortality and spleen rupture (Fisher’s test)	4.8	1	0.028

df: Degree of freedom.