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

Table 1 Case reports of hepatic injuries during colonoscopy

Ref.	Type of injury	Age, sex, and risk factors	Presentation	Treatment	Comments
Ellis et al[16], 1979	Combined liver and spleen	33-year-old female, her manifestations and colonoscopy findings were suggestive of IBD	Left upper quadrant followed by hemodynamic instability	Surgical	The spleen ruptured, laceration to left liver lobe, injury to mesocolon. Ruptured? IBD related adhesions were seen
Noreña et al[18], 2013	Lone liver injury	73-year-old male, undergoing a screening colonoscopy	Severe right upper abdominal pain radiating to lumbar region with abdominal distension and rigidity	Laparoscopic evaluation and drainage were done with conservative management	A subcapsular hepatic hematoma and a right hepatic; lobe laceration as well as a large hemoperitoneum
Jammal et al[19], 2013	Lone liver injury	30-year-old woman undergoing screening colonoscopy for polyps	Right upper quadrant pain radiating to the right scapula	Conservative	Abdominal ultrasonography and CT achieved diagnosis of a subcapsular hematoma
Hussain et al[20], 2020	Combined liver and spleen	A 71-year-old woman with many medical co-morbidities had an EGD; and colonoscopy for nonspecific abdominal pain	Brought to emergency room in code blue hours after having colonoscopy	Emergency laparotomy with splenectomy and hepatorrhaphy	Adhesion of omentum to bilateral abdominal wall and pelvis. The patient passed away dye to brain hypoxic events

IBD: Inflammatory bowel diseases; EGD: Esophagogastroduodenoscopy; CT: Computed tomography.

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.