1/5. splenic rupture following colonoscopy: rare in the UK?Splenic injury following colonoscopy is rare, with only 28 cases reported so far in the English language literature. Direct trauma during colonoscopy or traction on the spleno-colic ligament is the proposed mechanism of injury. Computed tomography (CT) of the abdomen is usually considered to be the most sensitive and specific modality for diagnosis. We report a case of a 56-year-old female, who was diagnosed having a splenic rupture following a routine colonoscopy for investigation of anaemia. She underwent an emergency laparotomy with splenectomy and made a satisfactory recovery post-operatively. We wish to highlight that there should be a high index of suspicion of splenic rupture in patients presenting with abdominal pain and demonstrating a positive Kehr's sign following colonoscopy. Only two case reports from the United Kingdom have been published, raising the possibility of under-reporting of such cases.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/5. Rare complications following colonoscopy: case reports of splenic rupture and appendicitis.BACKGROUND: appendicitis and splenic rupture are 2 rare complications of colonoscopy reported in the literature. To our knowledge splenic rupture following colonoscopy has been reported 17 times in the English-language literature and is associated with excess traction on the splenocolic ligament. appendicitis after colonoscopy has been reported only 9 times and is usually associated with obstruction of the appendiceal lumen with fecal matter during colonoscopy. methods: We present the case reports of 2 patients: a 76-year-old woman who presented in consultation 24 hours after a routine colonoscopy with massive hemoperitoneum secondary to splenic rupture, seen on computed tomographic (CT) scan, who then underwent splenectomy; the second, a 60-year-old male who presented to the emergency room 16 hours after colonoscopy with clinical and computed tomographic scan findings of acute appendicitis who underwent a laparoscopic appendectomy. RESULTS: Treatment of both patients resulted in resolution of their complications, splenic rupture and appendicitis. They both had an uneventful postoperative course and are doing well several months postoperatively. CONCLUSIONS: We report 2 rare complications of colonoscopy, splenic rupture and appendicitis. In the setting of a recent colonoscopy and abdominal pain, a high index of suspicion is needed for their diagnosis.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
3/5. splenosis: an unusual cause of intraabdominal hemorrhage.A 31-year-old female presented to the emergency department with an acute onset of severe abdominal pain. She developed hypovolemic shock from an intra-abdominal bleed. At laparotomy she was found to be bleeding from two areas of splenosis on the uterine ligament. The patient had sustained a ruptured spleen 22 years prior and had no symptomatology from her areas of splenosis. A short review of splenosis is presented.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
4/5. Splenic injury during colonoscopy.Splenic injury was associated with a flexible fiberoptic colonoscopy and required an urgent splenectomy. Injuries to viscera other than the colon during colonoscopy are rare, and the diagnosis is frequently delayed. Excessive traction on the splenocolic ligament or on preexisting adhesions, resulting in capsular tears, is the presumed mechanism of injury. Although computed tomography may be helpful, the greatest aid to an early diagnosis is the knowledge that this complication may occur.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
5/5. splenic rupture: an unusual complication of colonoscopy.splenic rupture is an uncommon complication of colonoscopy. A high index of suspicion is a crucial factor in the prompt diagnosis of this rare but potentially fatal complication. We report a case of splenic rupture diagnosed 3 days after a colonoscopy and requiring splenectomy. We also reviewed 17 reported cases of splenic rupture after colonoscopy, including our case. The presumed mechanisms of splenic rupture during colonoscopy are direct trauma to the spleen, excessive splenocolic ligament traction, and decrease in the relative mobility between the spleen and the colon. Of the 17 cases reviewed, 10 had polypectomy and/or biopsy performed during colonoscopy. Other probable risk factors are identified and tabulated. The hemodynamic status of the patient is the primary factor used to determine the therapeutic option. Computed tomographic (CT) scan of the abdomen reliably demonstrates well-contained splenic laceration and subcapsular hematoma, and differentiates these splenic complications from perisplenic clot and hemoperitoneum. Thus, CT scan may help decide which patients may be managed operatively or nonoperatively. splenectomy is the operative procedure of choice for splenic rupture after colonoscopy. Conservative management includes broad spectrum antibiotics, intravenous fluids, blood transfusion, and close hemodynamic monitoring. The factors mandating further evaluation of persistent abdominal pain after colonoscopy are hemodynamic instability, clinical features of acute abdomen, leukocytosis, and/or acute anemia. The onset of abdominal pain associated with one or more of these critical factors is usually within 24 h after colonoscopy. An emergent CT scan of the abdomen is the modality of choice to further evaluate these clinical features, but intestinal perforation and external bleeding must first be excluded.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |