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

Abstract

Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure. Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used, the sedatives used, but to the procedure related as well including bleeding and perforation. Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon, however, serious complications related to the procedure have been reported infrequently in the literature. Life threatening injuries to the spleen, liver, pancreas, mesentery, and urinary bladder have been reported as early as in mid-1970s. These injuries should not be overlooked by clinicians and endoscopists. Steadily increasing abdominal pain, abdominal distension, and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury. Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening. Although conservative management may help, yet they usually need interventional radiology or surgical intervention. Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively. The mechanism of abdominal organ injuries during colonoscopy is not fully understood, however many risk factors have been identified, which can be classified as- organ related, procedure related, and local abdominal factors. Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries. Left lateral position, avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.

Keywords: Colonoscopy; Pancreatitis; Trauma; Complications; Adhesions

Core Tip: Although colonoscopy is seen as a potentially safe procedure performed as a daycare practice, yet it is associated with a wide range of complications. Emerging evidence in the literature documents injuries to abdominal organs beyond the bowel wall. The most commonly affected organ is the spleen, followed by the pancreas and infrequently the liver, mesentery and urinary bladder. Despite its low frequency, some cases are serious especially the rupture of visceral organs like spleen. In such cases, conservative management may not always work and interventional radiologic procedures and/or surgery may be required.