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Presentation and Management of Splenic Injury After Colonoscopy: A Systematic Review

Piccolo, Gaetano MD*; Di Vita, Maria MD*; Cavallaro, Andrea MD*; Zanghì, Antonio MD*; Lo Menzo, Emanuele MD; Cardì, Francesco MD*; Cappellani, Alessandro MD*

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: April 2014 - Volume 24 - Issue 2 - p 95–102
doi: 10.1097/SLE.0b013e3182a83493
Review Articles

This study reviewed all single experience of splenic injuries after colonoscopy in the last 40 years to define the possible risk factors and the management of this complication. A MEDLINE and a PubMed search was undertaken to identify articles in English, French, Spanish, and Italian from 1974 to 2012 using the key words: “splenic injury,” “splenic rupture,” and “colonoscopy.” Data were analyzed using descriptive statistic. A total of 103 cases have been described in 75 reports. The majority of the patients were women (71.56%) and 6.85% underwent previous pelvic surgery. The mean age was 63 years (range, 29 to 90 y). About 61 of the 103 studies (59.2%) reported the presence or the absence of previous abdominal surgery and within these, only 31 of 61 patients (50.82%) underwent previous abdominal surgery. In this review, over half of the patients with splenic injury underwent colonoscopy for routine surveillance (62.75%), and only one third of the splenic injures were associated with biopsy or polypectomy. The majority of patients (78.57%) developed symptoms within the first 24 hours after colonoscopy and in a minority of cases (21.43%), there was a delayed presentation 24 hours after colonoscopy. Computed tomography was used as the primary modality to make the diagnosis in 69 of 98 cases (70.41%) and as a confirmatory test in many additional cases. Twenty-six of 102 patients (25.49%) were treated by conservative methods, whereas the majority of patients (69.61%) underwent splenectomy as a definitive treatment. Because of possible medicolegal implications, the endoscopists should consider mentioning splenic injury on the consent form of colonoscopy after bowel perforation and bleeding, particularly in higher risk patients.

*Department of Surgery, University of Catania, Catania, Italy

Digestive Disease Institute, Cleveland Clinic Boulevard, Weston, FL

The author declares no conflicts of interest.

Reprints: Gaetano Piccolo, MD, Department of Surgery, University of Catania, Via S. Sofia 84, Catania 95123, Italy (e-mail:

Received February 25, 2013

Accepted August 3, 2013

© 2014 by Lippincott Williams & Wilkins