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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
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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: schaky@hotmail.it).

Received February 25, 2013

Accepted August 3, 2013

© 2014 by Lippincott Williams & Wilkins