Trauma to the solid abdominal organs: The missed dark box of colonoscopy

Table 2 Case reports of pancreatic injuries during colonoscopy

Ref.	Type of injury	Age, sex, and risk factors	Presentations	Treatment	Comments
Sidiqi and Gong[5], 2019	Acute pancreatitis	53-yr-old female	Epigastric pain with nausea and vomiting	Conservative	Probably direct trauma to tail of the pancreas by movement of the endoscope
Limb et al[6], 2016	Acute pancreatitis	69-yr-old female, multiple abdominal surgeries, and previous episode of acute pancreatitis	Epigastric pain	Conservative	Crohn’s disease; controlled under mesalazine therapy
Thomas and Mitre[22], 1994	Acute pancreatitis	A 25-yr-old male, technical difficulties with passage of the scope beyond the splenic flexure after manipulations, position change and external abdominal pressure	Mid-epigastric pain with nausea and vomiting	Conservative	Alpha loop formation. The pancreatic inflammation was limited to the tail (close proximity to splenic flexure)
Khashram and Frizelle[24], 2011	Hemorrhage around tail of pancreas	Trauma of insufflation transmitted to the pancreas	Epigastric pain	Conservative
Ahmed et al[32], 2019	Pancreatic duct leak	62-yr-old female, prior left nephrectomy	Worsening left sided abdominal pain, nausea and vomiting	ERCP with PD stenting	A collection involving pancreatic tail and splenic flexure (possible following adhesions of the prior surgery) was seen in the CT

ERCP: Endoscopic retrograde cholangiopancreatography; PD: Pancreaticoduodenectomy; CT: Computed tomography.