|
1
|
Howell S, Barton T, Pourshams IA, Eckman C. Subcapsular Splenic Hematoma After Diagnostic Colonoscopy: A Case Report. Cureus 2024; 16:e69850. [PMID: 39435234 PMCID: PMC11493109 DOI: 10.7759/cureus.69850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2024] [Indexed: 10/23/2024] Open
Abstract
Colonoscopy is a widely performed diagnostic and therapeutic procedure essential for the screening, diagnosis, and management of various colorectal conditions. It is a routine and relatively safe procedure. Unfortunately, sometimes complications arise, one of the rarest being splenic injury. A splenic hematoma following colonoscopy can lead to significant morbidity and can be fatal if not promptly recognized and managed. We report a case of a 58-year-old female who initially refused imaging after presenting to the ED with abdominal pain following her procedure, but then presented again days later and was found to have a splenic hematoma and hemoperitoneum. She was ultimately managed medically and after an uneventful hospital course and was able to be discharged without requiring a splenectomy.
Collapse
Affiliation(s)
- Shawn Howell
- Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, USA
| | - Taylor Barton
- Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, USA
| | - Idean A Pourshams
- Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, USA
| | | |
Collapse
|
|
2
|
Echevarria A, Hershfeld B, Arciero E, Verma R. Splenic rupture following prone lateral discectomy and arthrodesis: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE23639. [PMID: 39008909 PMCID: PMC11248748 DOI: 10.3171/case23639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/29/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The prone lateral approach to lumbar spine surgery is known to have a multitude of potential complications, including damage to neurovascular structures, surrounding viscera, and intra-abdominal structures near the surgical site. However, iatrogenic injury to the spleen following prone lateral lumbar discectomy and arthrodesis as a potential complication has not yet been described in the literature. OBSERVATIONS The authors present the case of a 71-year-old female with a history of L3-S1 laminectomy and L3-5 arthrodesis who underwent a prone lateral discectomy of L2-3 with arthrodesis of the endplates for chronic lower-back pain. On postoperative day 1, the patient developed hypotension unresponsive to pressor medications, significant abdominal pain, and anemia requiring 2 transfusions. Bedside ultrasound revealed free fluid in the abdomen. She then underwent an exploratory laparotomy for splenic injury. LESSONS Although rare, splenic rupture should be considered as part of the differential diagnosis for patients with hemodynamic instability after lateral surgical approaches to the lumbar spine. Any patient with evidence of hypotension, anemia, and/or abdominal pain following lumbar surgery should be evaluated for splenic injury with an abdominal computed tomography scan and considered for surgical intervention. https://thejns.org/doi/10.3171/CASE23639.
Collapse
Affiliation(s)
- Alexandra Echevarria
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Benjamin Hershfeld
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Emily Arciero
- Northwell Health Department of Orthopedic Surgery, NorthShore University Hospital, Manhasset, New York
| | - Rohit Verma
- Northwell Health Department of Orthopedic Surgery, NorthShore University Hospital, Manhasset, New York
| |
Collapse
|
|
3
|
Chen Z, Yu L, Liu J, Kong J, Deng X, Guo X, Shan J, Zhou D, Li W, Lin Y, Huang W, Zeng W, Shi X, Bai Y, Fan H. Gut microbiota dynamics and fecal SCFAs after colonoscopy: accelerating microbiome stabilization by Clostridium butyricum. J Transl Med 2024; 22:222. [PMID: 38429821 PMCID: PMC10908214 DOI: 10.1186/s12967-024-05031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/24/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Colonoscopy is a classic diagnostic method with possible complications including abdominal pain and diarrhoea. In this study, gut microbiota dynamics and related metabolic products during and after colonoscopy were explored to accelerate gut microbiome balance through probiotics. METHODS The gut microbiota and fecal short-chain fatty acids (SCFAs) were analyzed in four healthy subjects before and after colonoscopy, along with seven individuals supplemented with Clostridium butyricum. We employed 16S rRNA sequencing and GC-MS to investigate these changes. We also conducted bioinformatic analysis to explore the buk gene, encoding butyrate kinase, across C. butyricum strains from the human gut. RESULTS The gut microbiota and fecal short-chain fatty acids (SCFAs) of four healthy subjects were recovered on the 7th day after colonoscopy. We found that Clostridium and other bacteria might have efficient butyric acid production through bioinformatic analysis of the buk and assessment of the transcriptional level of the buk. Supplementation of seven healthy subjects with Clostridium butyricum after colonoscopy resulted in a quicker recovery and stabilization of gut microbiota and fecal SCFAs on the third day. CONCLUSION We suggest that supplementation of Clostridium butyricum after colonoscopy should be considered in future routine clinical practice.
Collapse
Affiliation(s)
- Zhenhui Chen
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Lu Yu
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiaxin Liu
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jingjing Kong
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiaoshi Deng
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiaotong Guo
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jiamin Shan
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Daixuan Zhou
- Guangdong Provincial Key Laboratory of Gastroenterology, Inst. Of Gastroenterology of Guangdong Province, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wendan Li
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yangfan Lin
- Guangdong Provincial Key Laboratory of Gastroenterology, Inst. Of Gastroenterology of Guangdong Province, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wanwen Huang
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Weisen Zeng
- Department of Cell Biology, School of Basic Medicine, Southern Medical University, Guangzhou, China
| | - Xinlong Shi
- Department of Colorectal Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Yang Bai
- Guangdong Provincial Key Laboratory of Gastroenterology, Inst. Of Gastroenterology of Guangdong Province, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Hongying Fan
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China.
| |
Collapse
|
|
4
|
Lukies M, Clements W. Splenic artery embolisation for splenic injury during colonoscopy: A systematic review. United European Gastroenterol J 2024; 12:44-55. [PMID: 38047383 PMCID: PMC10859723 DOI: 10.1002/ueg2.12498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/21/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Splenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low-grade injuries or with splenectomy for high-grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes of published cases of splenic injury due to colonoscopy treated with splenic artery embolisation. METHODS A systematic review was performed of published articles concerning splenic injury during colonoscopy treated primarily with splenic artery embolisation, splenectomy, or splenorrhaphy from 1977 to 2022. Datapoints included demographics, past surgical history, indication for colonoscopy, delay to diagnosis, treatment, grade of injury, splenic artery embolisation location, splenic preservation (salvage), and mortality. RESULTS The 30 patients treated with splenic artery embolisation were of mean age 65 (SD 9) years and 67% female, with 83% avoiding splenectomy and 6.7% mortality. Splenic artery embolisation was proximal to the splenic hilum in 81%. The 163 patients treated with splenectomy were of mean age 65 (SD 11) years and 66% female, with 5.5% mortality. Three patients treated with splenorrhaphy of median age 60 (range 59-70) years all avoided splenectomy with no mortality. There was no difference in mortality between splenic artery embolisation and splenectomy cohorts (p = 0.81). CONCLUSIONS Splenic artery embolisation is an effective treatment option in splenic injury due to colonoscopy. Given the known benefits of splenic salvage compared to splenectomy, including preserved immune function against encapsulated organisms, low cost, and shorter hospital length of stay, embolisation should be incorporated into treatment pathways for splenic injury due to colonoscopy in suitable patients.
Collapse
Affiliation(s)
- Matthew Lukies
- Department of RadiologyAlfred HealthMelbourneVictoriaAustralia
| | - Warren Clements
- Department of RadiologyAlfred HealthMelbourneVictoriaAustralia
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
- National Trauma Research InstituteMelbourneVictoriaAustralia
| |
Collapse
|
|
5
|
Ahmed B, Sheikhzadeh P, Changizi V, Abbasi M, Soleymani Y, Sarhan W, Rahmim A. CT radiomics analysis of primary colon cancer patients with or without liver metastases: a correlative study with [ 18F]FDG PET uptake values. Abdom Radiol (NY) 2023; 48:3297-3309. [PMID: 37453942 DOI: 10.1007/s00261-023-03999-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Utilizing [18F]Fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computed Tomography ([18F]FDG PET/CT) scans on primary colon cancer (CC) patients including with liver metastases (LM), we aimed to determine the relationship between structural CT radiomic features and metabolic PET standard uptake value (SUV) in these patients. MATERIAL AND METHOD A retrospective analysis was performed on 60 patients with primary CC, of which 40 had liver metastases that were more than 2 cm in diameter. [18F]FDG PET/CT was used to calculate SUVmax, and 42 CT radiomic characteristics were extracted from non-enhanced CT images. Tumors were manually segmented on fused PET/CT scans by two experienced nuclear medicine physicians. Sixty primary CC and forty LM lesions were segmented accordingly. In the cases of multiple LM lesions, the lesion with the largest diameter was chosen for segmentation. In a univariate analysis approach, we used Spearman correlation with multiple testing correction (Benjamini-Hutchberg false discovery rate (FDR), α = 0.05) to ascertain the relationship between SUVmax and CT radiomic features. RESULT Twenty-two (52.3%) and twenty-six (61.9%) CT radiomic features were found to be significantly correlated with SUVmax values of primary CC (n = 60) and LM (n = 40) lesions, respectively (FDR-corrected p value < 0.05 and 0.6 < |ρ| < 1). GLCM_homogeneity (ρ = 0.839), GLCM_dissimilarity (ρ = - 0.832), GLZLM_ZLNU (ρ = 0.827), and GLCM_contrast (ρ = - 0.815) were the 4 features most correlated with SUVmax in CC. On the other hand, in LM, the 4 features most correlated with SUVmax were GLRLM_LRHGE (ρ = 0.859), GLRLM_LRE (ρ = 0.859), GLRLM_LRLGE (ρ = 0.857), and GLRLM_RP (ρ = - 0.820). CONCLUSION We investigated the relationship between SUVmax of preoperative primary CC lesions and their LM with CT radiomic features. We found some CT radiomic features having relationships with the metabolic characteristics of lesions. This work suggests that non-invasive predictive imaging biomarkers for precision medicine can be derived from CT radiomic.
Collapse
Affiliation(s)
- Badr Ahmed
- Department of Radiology Technology and Radiotherapy, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Sheikhzadeh
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Vahid Changizi
- Department of Radiology Technology and Radiotherapy, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrshad Abbasi
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Yunus Soleymani
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Wisam Sarhan
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Nuclear Medicine International Hospital for Cancer and Nuclear Medicine, University of Kufa, Najaf, Iraq
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
- Departments of Radiology and Physics, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
|
6
|
Tanrıverdi S, Parlar Kılıç S. The Effect of Progressive Muscle Relaxation on Abdominal Pain and Distension in Colonoscopy Patients. J Perianesth Nurs 2023; 38:224-231. [PMID: 36328945 DOI: 10.1016/j.jopan.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 03/07/2022] [Accepted: 04/24/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE This study was conducted to examine the effect of progressive muscle relaxation on abdominal pain and distension in colonoscopy patients. DESIGN A randomized controlled experimental design. METHODS The experimental group was informed about progressive muscle relaxation (PMR) and an audio recording was provided. After the colonoscopy, abdominal pain (Visual Analogue Scale (VAS) pain) and distension (VAS distension) scores were assessed, then PMR was applied for 30 minutes and pain scores were determined again. VAS pain and VAS distension scores of the control group were determined after colonoscopy and 30 minutes later. VAS abdominal pain and VAS distension scores were evaluated at the 2nd, 4th, 8th, 12th, 16th, and 24th hour after the procedure on all patients. The day after the colonoscopy, post-test data were collected. FINDINGS The pretest VAS pain and VAS distension mean scores were similar in the intervention and control groups (P > .05). The mean VAS pain and VAS distension scores decreased significantly in the intervention group post procedure (P < .05). CONCLUSIONS PMR was determined to be effective in reducing abdominal pain and distension after colonoscopy.
Collapse
|
|
7
|
Galanis I, Simou M. Splenic Injury After Colonoscopy in a 55-Year-Old Female Patient. Cureus 2023; 15:e35239. [PMID: 36968869 PMCID: PMC10038689 DOI: 10.7759/cureus.35239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
Colonoscopy is, in general, a relatively safe procedure with a low complication rate. Splenic injury related to this procedure is very rare, ranging from one in 100,000 to one in 6,387 colonoscopies, but a possibly lethal complication. For its diagnosis, a high degree of clinical suspicion is needed as many physicians are not aware of its existence. Clinical symptoms and signs are observed 1-10 days after the procedure. The imaging modality of choice is contrast-enhanced computed tomography (CECT). However, contrast-enhanced ultrasound (CEUS) may also be used to detect abdominal fluid and the injured area of the spleen. We present a case of a 55-year-old female with splenic rupture after a colonoscopy, diagnosed with CEUS and CECT. Splenectomy was performed, and the patient's recovery was uneventful.
Collapse
|
|
8
|
Ishigaki K, Nakai Y, Inokuma A, Suzuki Y, Noguchi K, Kanai S, Suzuki T, Sato T, Hakuta R, Saito K, Saito T, Takahara N, Hamada T, Mizuno S, Kogure H, Nakai Y, Fujishiro M. Intra‐abdominal hemorrhage as a rare complication of endoscopic ultrasonography: A case report. DEN OPEN 2022; 2:e80. [PMID: 35310736 PMCID: PMC8828215 DOI: 10.1002/deo2.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/15/2021] [Accepted: 10/31/2021] [Indexed: 11/08/2022]
Abstract
Intra‐abdominal hemorrhage after endoscopic ultrasonography (EUS) is an uncommon complication, which can lead to potentially fatal outcomes. We describe a case of intra‐abdominal hemorrhage due to left gastric arterial bleeding after EUS. The patient developed severe epigastric pain 10 h after diagnostic EUS for pancreatic cysts. Contrast‐enhanced computed tomography revealed extravasation from the left gastric artery as well as a hematoma in the lesser omentum, which was confirmed by emergent angiography. Spontaneous hemostasis was obtained without embolization and the patient did not have further episodes of intra‐abdominal hemorrhage. Endoscopists should be aware of this rare but serious complication after endoscopic procedures.
Collapse
Affiliation(s)
- Kazunaga Ishigaki
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
- Department of Chemotherapy Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Yousuke Nakai
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
- Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Akiyuki Inokuma
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Yukari Suzuki
- Department of Gastroenterology Japanese Red Cross Medical Center Tokyo Japan
| | - Kensaku Noguchi
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Sachiko Kanai
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Tatsunori Suzuki
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Tatsuya Sato
- Department of Gastroenterology Kanto Central Hospital Tokyo Japan
| | - Ryunosuke Hakuta
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
- Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Kei Saito
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Tomotaka Saito
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Naminatsu Takahara
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Suguru Mizuno
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Hirofumi Kogure
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Yudai Nakai
- Department of Radiology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| |
Collapse
|
|
9
|
Abensur Vuillaume L, Bourgeois-Lattanzi A, Abensur R. Hématome splénique au décours d’une coloscopie. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
|
10
|
Dziadkowiec KN, Stawinski PM, Radadiya D, Katz A. Left Shoulder Pain After Routine Colonoscopy: An Unusual Presentation of Splenic Laceration. Cureus 2020; 12:e7755. [PMID: 32455072 PMCID: PMC7243060 DOI: 10.7759/cureus.7755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 11/05/2022] Open
Abstract
Splenic injury is an uncommon complication following a colonoscopy procedure. Splenic laceration typically presents with post-procedural abdominal pain. We present a case of non-specific shoulder pain, following an uneventful routine colonoscopy and highlight the importance of maintaining a high degree of clinical suspicion for the general gastroenterologist.
Collapse
Affiliation(s)
- Karolina N Dziadkowiec
- Internal Medicine, University of Miami, John F. Kennedy Regional Campus, West Palm Beach, USA
| | - Peter M Stawinski
- Internal Medicine, University of Miami, John F. Kennedy Regional Campus, Atlantis, USA
| | - Dhruvil Radadiya
- Internal Medicine, East Tennessee State University, Johnson City, USA
| | - Aviv Katz
- Internal Medicine, John F. Kennedy Medical Center, Atlantis, USA
| |
Collapse
|
|
11
|
Ullah W, Rashid MU, Mehmood A, Zafar Y, Hussain I, Sarvepalli D, Hasan MK. Splenic injuries secondary to colonoscopy: Rare but serious complication. World J Gastrointest Surg 2020; 12:55-67. [PMID: 32128029 PMCID: PMC7044106 DOI: 10.4240/wjgs.v12.i2.55] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/23/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colonoscopy is a safe and routine diagnostic and therapeutic procedure for evaluation of large bowel diseases. Most common procedure related complications include bleeding and perforation but rarely a splenic Injury.
AIM To investigate the reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients
METHODS A structured search on four databases was done and 45 articles with 68 patients were selected. The reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients were identified and analyzed using SPSS.
RESULTS The mean age of the patients was 62.7 years with 64% females. Twenty two percent had a complete splenic rupture with colonoscopy while 63% had subcapsular hematoma, spleen laceration and spleen avulsion. The most common reason for colonoscopy was screening (46%) followed by diagnostic colonoscopy (28%). Eighty seven percent of patients presented with abdominal pain. Patients with spleen rupture mostly required splenectomy (47%), while minor spleen hematomas and lacerations were managed conservatively (38%). Six percent of the patients were managed with proximal splenic artery splenic embolization and 4% were managed with laparoscopic repair. The overall mortality was 10% while 77% had complete recovery. The reason of colonoscopy against presentation specifically, abdominal pain showed no statistical significance P = 0.69. The indication of colonoscopy had no significant impact on incidence of splenic injury (P = 0.89). Majority of the patients (47%) were managed with splenectomy while the rest were managed conservatively (P = 0.04). This association was moderately strong at a cramer’s V test (0.34). The Fisher exact test showed a higher mortality with spleen rupture (P = 0.028).
CONCLUSION Spleen rupture due to colonoscopy is a significant concern and is associated with high mortality. The management of the patients can be individualized based on clinical presentation.
Collapse
Affiliation(s)
- Waqas Ullah
- Department of Internal Medicine, Abington Hospital, Abington, PA 19001, United States
| | - Mamoon Ur Rashid
- Department of Internal Medicine, Advent Health Hospital, Orlando, FL 32804, United States
| | - Asif Mehmood
- Department of Internal Medicine, Geisinger Medical Center, Danville, PA 17822, United States
| | - Yousaf Zafar
- Department of Internal Medicine, UMKC, 5100 Rockhill Rd, Kansas City, MO 64110, United States
| | - Ishtiaq Hussain
- Department of Gastroenterology, Cleveland Clinic, Weston, FL 33331, United States
| | - Deepika Sarvepalli
- Department of Internal Medicine, Advent Health Hospital, Orlando, FL 32804, United States
| | - Muhammad Khalid Hasan
- Department of Gastroenterology, Advent Health Hospital, Orlando, FL 32804, United States
| |
Collapse
|
|
12
|
Cullinane C, Gudyma J, McArdle G. Emergency splenectomy postelective colonoscopy. BMJ Case Rep 2017; 2017:bcr-2016-219083. [PMID: 28473360 DOI: 10.1136/bcr-2016-219083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Colonoscopy is the gold standard for investigation of colorectal carcinoma and inflammatory bowel disease. Splenic injury is a rare but potentially fatal complication of colonoscopy. The present case study outlines the early clinical presentation and rapid deterioration of a patient with a splenic injury after an elective colonoscopy. A 70-year-old female underwent a colonoscopy for investigation of altered bowel habit. The procedure was documented as difficult due to the presence of 'stiff loopy colon'. In recovery, patient's condition deteriorated and she was moved to the ward for further assessment. She gradually became haemodynamically unstable and displayed signs of peritoneal irritation. Initial attempts of fluid resuscitation failed to improve patient's clinical condition. Further testing revealed a significant drop in haemoglobin and CT confirmed the diagnosis of a splenic rupture. She underwent an emergency splenectomy that evening. Postoperatively she was managed in the high dependency unit.
Collapse
Affiliation(s)
| | - Jaroslaw Gudyma
- General Surgery, Daisy Hill Hospital, Newry, County Down, UK
| | - Gerarde McArdle
- General Surgery, Daisy Hill Hospital, Newry, County Down, UK
| |
Collapse
|
|
13
|
García García MJ, Castañera González R, Martín Rivas B, Gómez Ruiz M, Rivero Tirado M. Splenic rupture after colorectal cancer screening. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 107:705-6. [PMID: 26541662 DOI: 10.17235/reed.2015.3714/2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The number of colonoscopies performed in recent years is increasing dramatically, specially those related to colorectal cancer screening programmes. For this reason, there is a direct relationship with the number of exceptional complications such as splenic rupture. We describe a clinical case of a splenic rupture with hemodynamic instability. Consequently, an emergency splenectomy was performed 6 hours after the colonoscopy was finished. Health staff should be aware of its existence, as an early reaction will avoid more severe problems.
Collapse
|
|
14
|
Zappa MA, Aiolfi A, Antonini I, Musolino CD, Porta A. Splenic rupture following colonoscopy: Case report and literature review. Int J Surg Case Rep 2016; 21:118-20. [PMID: 26971282 PMCID: PMC4802200 DOI: 10.1016/j.ijscr.2016.02.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/01/2016] [Accepted: 02/29/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for colorectal diseases. Although bleeding and perforation are most common complications, extra colonic or visceral injuries have been described. Splenic rupture is rare with few cases reported in current literature. PRESENTATION OF CASE We report the case of a 73-year old man who presented to surgical consultation 50h after colonoscopy. Clinical, laboratory and imaging findings were suggestive for haemoperitoneum. At surgery an almost complete splenic disruption was evident and urgent splenectomy was performed. DISCUSSION Splenic injury following colonoscopy is exceptional, probably related to instrumental looping with excessive traction on the splenocolic ligament. In patients with an early presentation a sudden onset of symptoms is the rule. By contrast a delayed presentation (>48h) is nonspecific and subtle with arduous diagnosis. CONCLUSION Awareness of this potential complication, high level of suspicion and prompt treatment are at the basis of better outcomes in such patients.
Collapse
Affiliation(s)
- Marco Antonio Zappa
- University of Milan, Department of general and emergency surgery, Ospedale S. Famiglia Fatebenefratelli-Erba, Italy.
| | - Alberto Aiolfi
- University of Milan, Department of general and emergency surgery, Ospedale S. Famiglia Fatebenefratelli-Erba, Italy
| | - Ilaria Antonini
- University of Milan, Department of general and emergency surgery, Ospedale S. Famiglia Fatebenefratelli-Erba, Italy
| | - Cinzia Domenica Musolino
- University of Milan, Department of general and emergency surgery, Ospedale S. Famiglia Fatebenefratelli-Erba, Italy
| | - Andrea Porta
- University of Milan, Department of general and emergency surgery, Ospedale S. Famiglia Fatebenefratelli-Erba, Italy
| |
Collapse
|
|
15
|
Sbai H, Boukatta B, El Bouazzaoui A, Youssfi M, Mellouki I, Benajeh DA, Bobo M, Bohadouti H, Tizniti S, Ibrahimi A, Taleb KA, Kanjaa N. [Rare complication of colonoscopy in a patient on anticoagulant: haemoperitoneum by rupture of a subcapsular hematoma of the spleen, clinical case]. Pan Afr Med J 2015; 21:232. [PMID: 26523174 PMCID: PMC4607983 DOI: 10.11604/pamj.2015.21.232.1920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 03/19/2013] [Indexed: 01/10/2023] Open
Abstract
La coloscopie à visée diagnostique et/ou thérapeutique est un examen invasif fréquemment pratiquée de nos jours. La perforation colique et l'hémorragie digestive en sont les principales complications. La survenue d'un hémopéritoine par rupture d'un hématome sous-capsulaire splénique est une complication extrêmement rare et potentiellement mortelle de la coloscopie. Un traumatisme splénique minime passé inaperçu et la prise d'anticoagulant en sont des facteurs favorisants. Nous présentons le cas d'une rupture d'un hématome sous-capsulaire de la rate après une coloscopie, survenue chez un patient de 70 ans porteur d'une valve mitrale mécanique sous acénocoumarol à dose hypocaogulante. La nécessité d'obtention d'une anti coagulation rapidement efficace et l'instabilité hémodynamique avaient justifiée la réalisation d'une splénectomie. L’évolution était favorable. A travers cette observation clinique nous discutons les mécanismes et les modalités de prise en charge devant cette complication.
Collapse
Affiliation(s)
- Hicham Sbai
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Fès, Maroc
| | - Brahim Boukatta
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Fès, Maroc
| | | | | | | | | | - Meriem Bobo
- Service de Chirurgie Viscérale, CHU Hassan II, Fès, Maroc
| | | | - Siham Tizniti
- Service de Chirurgie Viscérale, CHU Hassan II, Fès, Maroc
| | - Adil Ibrahimi
- Service de Gastroentérologie, CHU Hassan II, Fès, Maroc
| | | | - Nabil Kanjaa
- Service d'Anesthésie Réanimation A4, CHU Hassan II, Fès, Maroc
| |
Collapse
|
|
16
|
Piccolo G, Di Vita M, Cavallaro A, Zanghì A, Lo Menzo E, Cardì F, Cappellani A. Presentation and management of splenic injury after colonoscopy: a systematic review. Surg Laparosc Endosc Percutan Tech 2014; 24:95-102. [PMID: 24686342 DOI: 10.1097/sle.0b013e3182a83493] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
Collapse
Affiliation(s)
- Gaetano Piccolo
- *Department of Surgery, University of Catania, Catania, Italy †Digestive Disease Institute, Cleveland Clinic Boulevard, Weston, FL
| | | | | | | | | | | | | |
Collapse
|
|
17
|
Parsché G, Brünnler T, Rockmann F, Pietsch C. Milzruptur nach einer Routine-Koloskopie. Notf Rett Med 2013. [DOI: 10.1007/s10049-013-1760-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
|
18
|
Acute colonoscopy-induced splenic rupture presenting to the emergency department. Case Rep Emerg Med 2013; 2013:436874. [PMID: 23476824 PMCID: PMC3588206 DOI: 10.1155/2013/436874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/05/2013] [Indexed: 12/16/2022] Open
Abstract
Splenic rupture due to colonoscopy is a rarely reported event in the emergency medicine literature. Patients experiencing such an occurrence are likely to report to the emergency department. This paper documents an 84-year-old female who presented to the emergency department with abdominal pain and nausea less than 24 hours following a colonoscopy. An abdominal ultrasound revealed splenomegaly and free fluid. An abdominal computed tomography was significant for a splenic laceration. She underwent radiologic guided embolization and recovered without incident. Emergency medicine physicians need to consider splenic rupture as a differential in patients presenting after colonoscopy with abdominal pain.
Collapse
|
|
19
|
Corcillo A, Aellen S, Zingg T, Bize P, Demartines N, Denys A. Endovascular treatment of active splenic bleeding after colonoscopy: a systematic review of the literature. Cardiovasc Intervent Radiol 2012; 36:1270-9. [PMID: 23262476 DOI: 10.1007/s00270-012-0539-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 11/22/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE Colonoscopy is reported to be a safe procedure that is routinely performed for the diagnosis and treatment of colorectal diseases. Splenic rupture is considered to be a rare complication with high mortality and morbidity that requires immediate diagnosis and management. Nonoperative management (NOM), surgical treatment (ST), and, more recently, proximal splenic artery embolization (PSAE) have been proposed as treatment options. The goal of this study was to assess whether PSAE is safe even in high-grade ruptures. METHODS We report two rare cases of post colonoscopy splenic rupture. A systematic review of the literature from 2002 to 2010 (first reported case of PSAE) was performed and the three types of treatment compared. RESULTS All patients reviewed (77 of 77) presented with intraperitoneal hemorrhage due to isolated splenic trauma. Splenic rupture was high-grade in most patients when grading was possible. Six of 77 patients (7.8 %) were treated with PSAE, including the 2 cases reported herein. Fifty-seven patients (74 %) underwent ST. NOM was attempted first in 25 patients with a high failure rate (11 of 25 [44 %]) and requiring a salvage procedure, such as PSAE or ST. Previous surgery (31 of 59 patients), adhesions (10 of 13), diagnostic colonoscopies (49 of 71), previous biopsies or polypectomies (31 of 57) and female sex (56 of 77) were identified as risk factors. In contrast, splenomegaly (0 of 77 patients), medications that increase the risk of bleeding (13 of 30) and difficult colonoscopies (16 of 51) were not identified as risk factors. PSAE was safe and effective even in elderly patients with comorbidities and those taking medications that increase the risk of bleeding, and the length of the hospital stay was similar to that after ST. CONCLUSION We propose a treatment algorithm based on clinical and radiological criteria. Because of the high failure rate after NOM, PSAE should be the treatment of choice to manage grade I through IV splenic ruptures after colonoscopy in hemodynamically stabilized patients.
Collapse
Affiliation(s)
- Antonella Corcillo
- Département de Médecine Interne, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,
| | | | | | | | | | | |
Collapse
|
|
20
|
Abunnaja S, Panait L, Palesty JA, Macaron S. Laparoscopic splenectomy for traumatic splenic injury after screening colonoscopy. Case Rep Gastroenterol 2012; 6:624-8. [PMID: 23139653 PMCID: PMC3492969 DOI: 10.1159/000343428] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Colonoscopy is a widespread diagnostic and therapeutic procedure. The most common complications include bleeding and perforation. Splenic rupture following colonoscopy is rarely encountered and is most likely secondary to traction on the splenocolic ligament. Exploratory laparotomy and splenectomy is the most commonly employed therapeutic intervention for this injury reported in the literature. We present the case of a patient with this potentially fatal complication who was treated successfully at our institution. To our knowledge it is the first report in the literature of laparoscopic splenectomy as a successful minimally invasive treatment of splenic rupture following colonoscopy. The patient was a 62-year-old female who underwent screening colonoscopy with polypectomies at the cecum, descending colon and rectum. Immediately following the procedure she developed abdominal pain and had a syncopal episode. Clinical, laboratory and imaging findings were suggestive of hemoperitoneum and a ruptured spleen. A diagnostic laparoscopy was emergently performed and revealed a grade IV splenic laceration and hemoperitoneum. Laparoscopic splenectomy was completed safely and effectively. The patient's postoperative recovery was uneventful. We conclude that splenic rupture after colonoscopy is a rare but dangerous complication. A high index of suspicion is required to recognize it early. Awareness of this potential complication can lead to optimal patient outcome. Laparoscopic splenectomy may be a feasible treatment option.
Collapse
Affiliation(s)
- Salim Abunnaja
- The Stanley Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Conn., USA
| | | | | | | |
Collapse
|
|
21
|
Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. BMC Emerg Med 2012; 12:11. [PMID: 22889306 PMCID: PMC3532171 DOI: 10.1186/1471-227x-12-11] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/28/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. METHODS Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. RESULTS We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. CONCLUSIONS Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.
Collapse
Affiliation(s)
- F Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, Health Sciences Centre, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
| | - Nicholas Sowers
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
|
22
|
Singla S, Keller D, Thirunavukarasu P, Tamandl D, Gupta S, Gaughan J, Dempsey D. Splenic injury during colonoscopy--a complication that warrants urgent attention. J Gastrointest Surg 2012; 16:1225-34. [PMID: 22450952 DOI: 10.1007/s11605-012-1871-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 03/07/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Colonoscopy is a safe procedure that is performed routinely worldwide. There is, however, a small but significant risk of splenic injury that is often under-recognized. Due to a lack of awareness about this injury, the diagnosis may be delayed, which can lead to an increased risk of morbidity as well as mortality. This paper presents a comprehensive review of the medical literature on colonoscopy-associated splenic injury and describes the clinical presentation and management of this rare but potentially life-threatening complication. MATERIALS AND METHODS A comprehensive literature search identified 102 patients worldwide, including patients from our experience, with splenic injury during colonoscopy. A meta-regression analysis was completed using a mixed generalized linear model for repeated measures to identify risk factors for this rare complication. RESULTS A total of 75 articles were identified and 102 patients were studied. The majority of the papers were in English (92 %). Only 23.4 % of patients (26/102) were reported prior to the year 2000. Among the patients reported after the year 2000, the majority (84.2 %, 64/76) were reported after 2005. There were more females (76.5 %), median age was 65 years (range, 29-90 years), and most of the colonoscopies were performed without difficulty (66.6 %). Nearly 67 % of patients presented within 24 h of colonoscopy with complaints ranging from abdominal pain to dizziness. The most common symptom was left upper quadrant pain (58 %), and CT scan was found to be the most sensitive tool for diagnosis. Seventy-three patients underwent operative intervention; 96 % of these were treated with splenectomy. Hemoglobin drop of more than 3 gm/dL was identified as the only significant predictor of operative intervention. The overall mortality rate was 5 %. CONCLUSION Splenic injury during colonoscopy is rare; however, it is associated with significant morbidity and mortality. Splenic injury warrants a high degree of clinical suspicion critical to prompt diagnosis, and early surgical consultation is warranted.
Collapse
Affiliation(s)
- S Singla
- Department of Surgery, Temple University Hospital, Philadelphia, PA, USA.
| | | | | | | | | | | | | |
Collapse
|
|
23
|
Zandonà C, Turrina S, Pasin N, De Leo D. Medico-legal considerations in a case of splenic injury that occurred during colonoscopy. J Forensic Leg Med 2012; 19:229-33. [PMID: 22520377 DOI: 10.1016/j.jflm.2011.12.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 11/08/2011] [Accepted: 12/27/2011] [Indexed: 02/07/2023]
Abstract
Colonoscopy has became the gold standard diagnostic and therapeutic treatment for rectum and colon diseases. The splenic injury is a rare complication of colonoscopy and relatively few cases (less than 70) have been reported in the literature so far. Here we present a case of splenic rupture identified in an 80 year-old man few hours after an apparently uneventful colonoscopy. Acknowledging a causal relationship between the lesion and the diagnostic procedures, we discuss the possible medico-legal implications with regard to professional liability considering the exceptional nature of such an event and the stance recently taken by the Italian law.
Collapse
Affiliation(s)
- Chiara Zandonà
- Department of Public Health and Community Medicine, Institute of Legal Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134 Verona, Italy
| | | | | | | |
Collapse
|
|
24
|
Abstract
Splenic injury is an uncommon complication of colonoscopy. Less than 100 cases are reported in the English language literature. The exact mechanism of injury to the spleen during colonoscopy is unknown; various authors propose several risk factors and possible mechanisms. Splenic injury can be graded or classified according to the extent of laceration and the severity of the resultant hematoma. The management options range from observation to emergency splenectomy. Computed tomography scan is the most important imaging modality to diagnose splenic injury. Early recognition and appropriate management is of paramount importance in the management of this condition. A high index of suspicion in a patient with persistent abdominal pain after colonoscopy is key especially when a perforated viscous is ruled out. This article outlines the clinical presentation of splenic injury after colonoscopy and delineates a management algorithm.
Collapse
|
|
25
|
Fishback SJ, Pickhardt PJ, Bhalla S, Menias CO, Congdon RG, Macari M. Delayed presentation of splenic rupture following colonoscopy: clinical and CT findings. Emerg Radiol 2011; 18:539-44. [PMID: 21887533 DOI: 10.1007/s10140-011-0982-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 08/15/2011] [Indexed: 12/17/2022]
Abstract
The purpose of this study is to investigate the clinical and CT findings in patients with symptomatic colonoscopy-induced splenic rupture, and to assess for common features among this cohort. Multi-center search yielded 11 adults with symptomatic splenic injury related to colonoscopy. Workup included abdominal CT in 10 (91%) cases and abdominal radiography in two patients (one patient had both). Colonoscopy findings, post-procedural course, and CT findings were systematically reviewed. Mean patient age was 62.2 years (range, 51-84 years); 8 (73%) of 11 were female. The majority (64%) of colonoscopies were for screening. No immediate complications were reported at optical colonoscopy; tortuosity/redundancy was noted in five cases. Except for a small (8 mm) polyp in one case and a large (10 mm) polyp in another, the remaining nine patients had either diminutive or no polyps. Only one patient presented with hemodynamic instability during post-colonoscopy recovery; the other ten had a delayed presentation ranging from 8 h to 8 days (mean, 2.1 days). All 11 patients presented with abdominal pain. CT was diagnostic for splenic injury with subcaspular and/or perisplenic hematoma in all ten CT cases. Hemoperitoneum was present in eight, visible splenic laceration in three cases, and splenic artery pseudoaneurysm in one case. Five patients underwent splenectomy (four emergent) and six patients were treated conservatively. Average hospital stay was 5.5 days (range, 3-10 days). Colonoscopy-induced splenic rupture characteristically presents as a delayed and often serious complication. In cases of apparent non-traumatic splenic hematoma or rupture at CT, eliciting a history of recent colonoscopy may identify the etiology.
Collapse
Affiliation(s)
- Shelby J Fishback
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center 600 Highland Ave., Madison, WI 53792-3252, USA
| | | | | | | | | | | |
Collapse
|
|
26
|
Bertoglio C, Roscio F, De Luca A, Colico C, Scandroglio I. Delayed presentation of splenic injury following diagnostic colonoscopy. Updates Surg 2011; 64:77-9. [PMID: 21660616 DOI: 10.1007/s13304-011-0086-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 05/30/2011] [Indexed: 12/16/2022]
Abstract
Splenic injury (SI) is a rare complication after colonoscopy, but should be considered in the differential diagnosis of acute abdominal pain following this procedure. We report a case of delayed rupture and review pertinent literature. A 70-year-old patient on oral warfarin intake underwent colonoscopy that diagnosed obstructive rectal cancer and elongated colon conditioning the endoscope's passage. After 48 h, patient experienced sharp abdominal pain with mild peritoneal signs. Contrast-enhanced CT scan evidenced large amount of abdominal-free blood collection from grade II SI. Hypovolemic shock occurred following brief clinical observation. Urgent laparotomic splenectomy and contextual Hartmann's procedure were then carried out. Postoperative course was uneventful and definitive histology confirmed splenic subcapsular haematoma and locally advanced adenocarcinoma. Perforation and bleeding more likely occurred after colonoscopy, while few cases of SI are reported in literature since 1974. Traction on the splenocolic ligament and direct trauma has been advocated as possible causes. Peritoneal adhesions and splenic diseases usually are predisposing factors although not confirmed in our patient. Anticoagulant therapy favoured delayed filling up of subcapsular haematoma while bowel obstruction added further surgical challenge. Rapid onset of hemorrhagic shock required urgent splenectomy that remains the procedure of choice among the literature reviewed.
Collapse
Affiliation(s)
- Camillo Bertoglio
- Busto Arsizio General Hospital, Department of General Surgery, Tradate, Italy.
| | | | | | | | | |
Collapse
|
|
27
|
Sachdev S, Thangarajah H, Keddington J. Splenic rupture after uncomplicated colonoscopy. Am J Emerg Med 2011; 30:515.e1-2. [PMID: 21450434 DOI: 10.1016/j.ajem.2011.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 01/11/2011] [Indexed: 12/15/2022] Open
Abstract
Colonoscopy is a commonly performed medical procedure generally considered safe and effective. Rare complications include postpolypectomy bleeding and perforation. A far less common and more unusual complication is splenic injury. We present the case of a patient who developed this very outcome, presenting to the emergency department with abdominal pain several hours after the procedure. The mechanism of such injury is not known but has been hypothesized to be either traction on the splenocolic ligament or previously formed adhesions, direct blunt injury, or special maneuvers used to advance the colonoscope. Patients typically present with severe abdominal pain less than 24 hours after the procedure and may demonstrate Kehr's sign. Computed tomographic imaging is the diagnostic method of choice, and suspicion of splenic injury should necessitate careful observation with potential for operative intervention.
Collapse
Affiliation(s)
- Sean Sachdev
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | | | | |
Collapse
|
|
28
|
Michetti CP, Smeltzer E, Fakhry SM. Splenic injury due to colonoscopy: analysis of the world literature, a new case report, and recommendations for management. Am Surg 2011; 76:1198-204. [PMID: 21140684 DOI: 10.1177/000313481007601117] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Splenic injury is a rare complication of colonoscopy. Most literature on the topic is case-report based. Our objective was to perform a comprehensive analysis of characteristics of splenic injury due to colonoscopy from available published reports in the world literature, to compare and contrast this entity with that of traumatic splenic injury, and provide recommendations for management based on the analysis. We reviewed the PubMed database without restrictions using the terms splenic trauma after colonoscopy, splenic rupture from colonoscopy, splenic injury following colonoscopy, and splenic complications of colonoscopy, and also reviewed the references from the resulting publications. Retrieved manuscripts (case reports, reviews, and abstracts) were reviewed by two authors, and data extracted for 15 specific characteristics of each patient reported using a standardized data collection tool. Data were analyzed using descriptive statistics. Splenic injury due to colonoscopy is extremely rare as reported in published literature. The majority of patients that seek medical attention have delayed symptoms, and most require splenectomy. Subcapsular hematoma is the most common injury pattern seen. Selection criteria for operative management may be extrapolated from management guidelines for traumatic splenic injury, although nonoperative failure rates are higher for splenic injury due to colonoscopy than for trauma.
Collapse
Affiliation(s)
- Christopher P Michetti
- Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, Virginia 22042, USA.
| | | | | |
Collapse
|
|
29
|
Abstract
Colonoscopy is a routine procedure done tens of thousands of times per year for screening purposes. The vast majority of these procedures are uneventful. There are, however, complications that can arise from this procedure, including hollow viscus perforation and hemorrhage. We present a case in which a lesser known complication of colonoscopy-splenic laceration-was cared for in our emergency department. This complication is unusual and not often cited in the literature, but is important to recognize and treat quickly. We present a case of a 67-year-old female who underwent a routine screening colonoscopy at our institution and presented to the emergency department several hours later complaining of abdominal pain. Ultimately, abdominal computed tomography showed a large splenic laceration, which was treated operatively. The diagnosis of splenic laceration should be considered for patients with continued abdominal pain post-colonoscopy when other etiologies have been evaluated and ruled out.
Collapse
|
|
30
|
Abstract
Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent.
Collapse
Affiliation(s)
- Tabraze Rasul
- Department of Surgery, Russells Hall Hospital, Dudley, West Midlands, Warwick, UK
| | | | | | | | | |
Collapse
|
|
31
|
Vilallonga R, Armengol Miró JR, Baena JA, Dot J, Armengol M. Rotura esplénica después de fibrocolonoscopia. Complicación excepcional. Cir Esp 2010; 87:57-8. [DOI: 10.1016/j.ciresp.2008.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 12/21/2008] [Indexed: 11/27/2022]
|
|
32
|
Splenic rupture as a complication of colonoscopy: report of a case. Surg Today 2009; 40:68-71. [PMID: 20037844 DOI: 10.1007/s00595-008-3977-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 12/19/2008] [Indexed: 10/20/2022]
Abstract
Colonoscopy is a common procedure with the rare complication of a splenic injury. The proposed mechanism of injury is excessive splenocolic ligament traction. The diagnosis is made by computed tomography and the treatment is determined by the patient's stability. Here we report a case of splenic injury during colonoscopy with failure to manage conservatively. A review of the literature and suggested guidelines are also provided.
Collapse
|
|
33
|
Kamath AS, Iqbal CW, Sarr MG, Cullinane DC, Zietlow SP, Farley DR, Sawyer MD. Colonoscopic splenic injuries: incidence and management. J Gastrointest Surg 2009; 13:2136-40. [PMID: 19830501 DOI: 10.1007/s11605-009-1064-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 09/29/2009] [Indexed: 01/31/2023]
Abstract
PURPOSE Splenic injuries that occur during colonoscopies are rare. There is no available incidence of this serious complication, and the literature is limited to case reports. Our study looks at single institution experience of splenic injuries during colonoscopy to define the incidence and management of this serious complication. METHODS All patients from 1980 through June 2008 sustaining a splenic injury during colonoscopy were reviewed. RESULTS Four patients (of 296,248 colonoscopies) sustained a splenic injury directly from colonoscopy performed at our institution (incidence 0.001%). Three additional patients were treated at our tertiary referral center after splenic injury from colonoscopy performed elsewhere. The mean age at the time of colonoscopy was 54 years (range 40-70 years). The most common presenting symptom was abdominal pain (n = 4) with a mean decrease in hemoglobin of 6.5 g/dl (range 4.5-8.5 g/dl). Splenic injury was diagnosed by computed tomography in five patients. Six patients received a mean of 5.5 U of packed red blood cells (range 2-14 U). All patients were managed with splenectomy, six patients within 24 h of the index colonoscopy, and one patient presented more than 24 h after initial colonoscopy. There was no evidence of preexisting splenic disease in any of the patients by surgical pathology, and there were no postoperative complications or deaths. The mean duration of stay was 10 days (range 7-15 days). All patients are alive at a median follow up of 22 months (range 1-164 months). CONCLUSION Splenic injury occurring during colonoscopy is a rare but serious complication. Patients presented with abdominal pain and a precipitous decrease in hemoglobin and have all required emergent splenectomy.
Collapse
Affiliation(s)
- Ashwin S Kamath
- Department of GI and General Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | | | | | | | | |
Collapse
|
|
34
|
Abstract
Iatrogenic splenic tear after a colonoscopy is a rare complication. Conditions predisposing to splenocolic adhesions such as previous abdominal surgery, pancreatitis, or inflammatory bowel disease may increase the risk of this injury after colonoscopy. We present a case of a 47-year-old woman with an iatrogenic splenic tear after a routine colonoscopy, who had several of these predisposing factors and required an urgent splenectomy.
Collapse
|
|
35
|
Skipworth JRA, Raptis DA, Rawal JS, Olde Damink S, Shankar A, Malago M, Imber C. Splenic injury following colonoscopy--an underdiagnosed, but soon to increase, phenomenon? Ann R Coll Surg Engl 2009; 91:W6-11. [PMID: 19416579 DOI: 10.1308/147870809x400994] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION We present a case of splenic rupture in a 71-year-old woman admitted 6 days following a diagnostic colonoscopy. She underwent an open splenectomy and made a delayed, but complete, recovery. We proceeded to perform a retrospective review of all relevant literature to assess the frequency of similar post-colonoscopy complications. MATERIALS AND METHODS Using relevant keywords, we identified 63 further PubMed reports of splenic injury associated with colonoscopy that were reported in English. FINDINGS We have described only the fourth report of splenic injury secondary to colonoscopy from a UK centre. Literature review reveals a mean age of 63 years and a female preponderance for this complication. Most patients present on the day of their colonoscopy with abdominal pain, anaemia, elevated white cell count and Kehr's sign. CT is the investigation of choice and splenectomy the definitive management of choice. Most patients make a routine recovery, with mortality rates of approximately 8%. There is likely to be an under-reporting of this complication from UK-based centres, with the majority of reports originating from Europe and US. This points to a possible under-diagnosis or under-recognition of this potentially fatal complication. The incidence of such post-colonoscopic complications may increase with the forthcoming introduction of the National Bowel Cancer Screening Programme.
Collapse
Affiliation(s)
- J R A Skipworth
- Department of Hepatopancreaticobiliary Surgery, University College Hospital, London, UK.
| | | | | | | | | | | | | |
Collapse
|
|
36
|
Ha JF, Minchin D. Splenic injury in colonoscopy: a review. Int J Surg 2009; 7:424-7. [PMID: 19638324 DOI: 10.1016/j.ijsu.2009.07.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 07/22/2009] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Splenic rupture secondary to colonoscopy was first reported in 1974 by Wherry and Zehner. It has an incidence of around 0.00005-0.017%, and a mortality rate of 5%. METHOD We performed a literature search to identify the demographic profile, risk factors, clinical presentations, diagnosis and management of this rare complication. RESULTS There were 66 patients (51 females and 14 males), with a median age of 65. The mortality rate was 4.5%. Majority (n=41, 62.1%) occurred in uneventful colonoscopies. Symptoms usually (74%) occurred within 24h, and 55.8% presented within 24h. Majority (93.9%) had some form of work-up done, with blood tests (78.8%) and CT (68.2%) being the most frequent. Laparotomy and splenectomy were done in over half (56.1%) of the patients. Splenic hematoma (47%), laceration (47%) and rupture (33.3%) were the most common findings. CONCLUSION Splenic injury is an important complication to be aware of as its number will continue to rise with the increasing numbers of colonoscopies being performed for colorectal diseases, and delayed diagnosis may result in adverse outcome for the patient.
Collapse
Affiliation(s)
- Jennifer Fong Ha
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands 6009, Western Australia, Australia.
| | | |
Collapse
|
|
37
|
Abstract
Splenic perforation represents a rare complication of colonoscopy. In our report we have reviewed the experience reported in the world literature, including proposed mechanisms, risk factors for splenic perforation and available management options. We have also discussed our concerns for under reporting. We had a total of 4 cases of splenic perforation following colonoscopies at our centre. One patient had a small splenic laceration repaired; two were observed closely and discharged without intervention. The patient mentioned below required a splenectomy.
Collapse
Affiliation(s)
- Lakshmi Pasumarthy
- Department of Medicine, York Hospital, 1001 S. George St, York, PA 17405, USA
| | - James Srour
- Department of Gastroenterology, York Hospital, 1001 S. George St, York, PA 17405, USA
| |
Collapse
|
|
38
|
Dioguardi N, Grizzi F, Fiamengo B, Russo C. Metrically measuring liver biopsy: A chronic hepatitis B and C computer-aided morphologic description. World J Gastroenterol 2008; 14:7335-44. [PMID: 19109867 PMCID: PMC2778117 DOI: 10.3748/wjg.14.7335] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe a quantitative analysis method for liver biopsy sections with a machine that we have named “Dioguardi Histological Metriser” which automatically measures the residual hepatocyte mass (including hepatocytes vacuolization), inflammation, fibrosis and the loss of liver tissue tectonics.
METHODS: We analysed digitized images of liver biopsy sections taken from 398 patients. The analysis with Dioguardi Histological Metriser was validated by comparison with semi-quantitative scoring system.
RESULTS: The method provides: (1) the metrical extension in two-dimensions (the plane) of the residual hepatocellular set, including the area of vacuoles pertinent to abnormal lipid accumulation; (2) the geometric measure of the inflammation basin, which distinguishes intra-basin space and extra-basin dispersed parenchymal leukocytes; (3) the magnitude of collagen islets, (which were considered truncated fractals and classified into three degrees of magnitude); and (4) the tectonic index that quantifies alterations (disorders) in the organization of liver tissue. Dioguardi Histological Metriser machine allows to work at a speed of 0.1 mm2/s, scanning a whole section in 6-8 min.
CONCLUSION: The results are the first standardized metrical evaluation of the geometric properties of the parenchyma, inflammation, fibrosis, and alterations in liver tissue tectonics of the biopsy sections. The present study confirms that biopsies are still valuable, not only for diagnosing chronic hepatitis, but also for quantifying changes in the organization and order of liver tissue structure.
Collapse
|
|
39
|
Abstract
Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insufflation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.
Collapse
|
|
40
|
Famularo G, Minisola G, De Simone C. Rupture of the spleen after colonoscopy: a life-threatening complication. Am J Emerg Med 2008; 26:834.e3-4. [PMID: 18774051 DOI: 10.1016/j.ajem.2008.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 12/28/2007] [Accepted: 01/01/2008] [Indexed: 10/21/2022] Open
Abstract
During colonoscopy, the risk of injuring the spleen or other viscera except the colon is negligible. We report here a patient in whom spleen rupture did complicate the very early course of colonoscopy, but this remains an extremely rare complication with no more than 50 cases so far described. Diagnosis may be difficult, and the risk of spleen rupture seems to be greatest within 24 hours of colonoscopy. Mechanisms leading to spleen injury in the setting of colonoscopy are unclear; however, direct trauma, colon distension by insufflated air, and the excessive traction on the splenocolic ligament may be involved. Patients with splenomegaly and those with preexisting adhesions are at greater risk for this complication. Patients complaining of persistent abdominal pain after colonoscopy should be closely monitored and aggressively investigated for the suspect of spleen injury and rupture.
Collapse
Affiliation(s)
- Giuseppe Famularo
- Department of Internal Medicine, San Camillo Hospital, Circonvallazione Gianicolense, 00152 Rome, Italy.
| | | | | |
Collapse
|
|
41
|
Heyworth BE, Schwab JH, Boachie-Adjei OB. Case reports: splenic rupture after anterior thoracolumbar spinal fusion through a thoracoabdominal approach. Clin Orthop Relat Res 2008; 466:2271-5. [PMID: 18546052 PMCID: PMC2492995 DOI: 10.1007/s11999-008-0318-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 05/07/2008] [Indexed: 01/31/2023]
Abstract
The anterior approach in spinal deformity surgery has increased in popularity in recent years. The thoracoabdominal approach to the thoracolumbar spine is associated with numerous possible complications, including injury to vital intraabdominal structures in close proximity to the area of exposure, such as the spleen. We describe the case of a 44-year-old woman who underwent an emergent exploratory laparotomy for progressive abdominal pain and hemodynamic instability that revealed splenic rupture two days after single-stage anterior spinal fusion with instrumentation for thoracolumbar kyphoscoliosis. Because the suspected etiology of the splenic hemorrhage was related to retraction, surgeons using the anterior approach should consider intermittent release of retractors and inspection of intraabdominal structures. Splenic rupture should be considered as part of the differential diagnosis for patients with hemodynamic instability after anterior approaches to the thoracolumbar spine.
Collapse
Affiliation(s)
- Benton E. Heyworth
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Joseph H. Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Oheneba B. Boachie-Adjei
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| |
Collapse
|
|
42
|
Huchon C, Estrade S, Montariol T, Stirnemann J, Bader G, Fauconnier A. Splenic rupture after laparoscopic surgery: a case report. J Minim Invasive Gynecol 2008; 15:116-8. [PMID: 18262160 DOI: 10.1016/j.jmig.2007.08.615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 08/09/2007] [Accepted: 08/18/2007] [Indexed: 10/22/2022]
Abstract
Splenic rupture is a rare and severe complication of laparoscopic surgery. We report a case of delayed splenic rupture as a severe complication of laparoscopy, occurring 5 days after surgery performed on a 52-year-old woman with history of abdominal surgery and with acute pelvic infection. Subcapsular hematoma, resulting in splenic rupture, may have been a result of overlooked puncture by the Veress needle or by tension on splenic adhesions during lysis. The diagnosis should be brought up during postoperative care in case of severe pain with hemodynamic failure, hemoglobin concentration decrease, or both.
Collapse
Affiliation(s)
- Cyrille Huchon
- Department of Obstetrics, Gynecology, and Reproductive Medicine, CHI Poissy Saint Germain en Laye, Poissy, France.
| | | | | | | | | | | |
Collapse
|
|
43
|
Saad A, Rex DK. Colonoscopy-induced splenic injury: report of 3 cases and literature review. Dig Dis Sci 2008; 53:892-8. [PMID: 17934832 DOI: 10.1007/s10620-007-9963-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 08/01/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND Since its first report in 1974, 66 cases of splenic injury after colonoscopy have been reported in the world literature. Splenic injury is among the rarest complications of colonoscopy. However, it can be associated with severe morbidity and has rarely been fatal. OBJECTIVES Three cases of splenic injury following colonoscopy are described, and the world literature is reviewed. METHODS Case reports and literature review. RESULTS Seventy-six percent of the patients were females. When reported, colonoscope insertion was technically difficult in 36% of cases. The onset of symptoms is usually within 48 h of colonoscopy. Abdominal pain was the most common presenting symptom (93% of cases). CT scan and ultrasound each had 100% diagnostic sensitivity when performed. Twenty of 65 cases (31%) with available data were successfully managed supportively with bed rest, transfusion and pain control. Hemodynamic instability was associated with surgical treatment, but no clinical features were perfect predictors of successful conservative therapy or the need for surgery. CONCLUSIONS Splenic injury during and after colonoscopy is more common in women. Technically difficult colonoscopy is a possible risk factor. Onset of symptoms is often delayed by hours. CT scan is probably the best diagnostic test for splenic injury after colonoscopy, though the literature indicated ultrasound is also sensitive. Patients with hemodynamic instability are most often operated. Patients with confined intrasplenic hematoma and hemodynamic stability can be given a trial of conservative management.
Collapse
Affiliation(s)
- Abdo Saad
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, 550 N. University Boulevard UH 4100, Indianapolis, IN 46202, USA
| | | |
Collapse
|
|
44
|
Pichon N, Mathonnet M, Verdière F, Carrier P. [Splenic trauma: an unusual complication of colonoscopy with polypectomy]. ACTA ACUST UNITED AC 2008; 32:123-7. [PMID: 18387425 DOI: 10.1016/j.gcb.2007.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 10/04/2007] [Indexed: 11/18/2022]
Abstract
Nowadays, colonoscopy has become an invaluable tool in the diagnosis and treatment of diseases of the colon and rectum. Colonoscopy is still an invasive exam with several complications. The most common complications are perforation and bleeding, which occur in up to 1% after diagnostic colonoscopy and 3% of patients undergoing therapeutic colonoscopy. Less common complications include pneumothorax, pneumomediastinum, colonic volvulus, hernia incarceration, retroperitoneal abscess and mesenteric tear. Splenic rupture is a rare and potentially lethal colonoscopic complication with less than 45 cases reported in the world. The overall incidence is 0.004%. Mechanisms of injury and available treatment options remain discussed. We present a case of splenic rupture after colonoscopy with polypectomy in a 73-year-old woman managed first with nonoperative treatment and nine days later with surgical treatment. As the indications for colonoscopy expand, including the introduction of mass screening for colorectal cancer, endoscopists should be increasingly aware of that life-threatening complication after colonoscopy and know the emergency treatment.
Collapse
Affiliation(s)
- N Pichon
- Service de réanimation polyvalente, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| | | | | | | |
Collapse
|
|
45
|
Cappellani A, Di Vita M, Zanghì A, Cavallaro A, Alfano G, Piccolo G, Lo Menzo E. Splenic rupture after colonoscopy: Report of a case and review of literature. World J Emerg Surg 2008; 3:8. [PMID: 18261241 PMCID: PMC2279110 DOI: 10.1186/1749-7922-3-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 02/09/2008] [Indexed: 11/25/2022] Open
Abstract
Splenic rupture is a rare complication of colonoscopy. For this reason the diagnosis could be delayed and the outcome dismal. Fifty-four cases of splenic rupture after colonoscopy have been described in the literature. The majority of the cases required emergent or delayed splenectomy, 13 of these cases were treated conservatively. The main feature that stands out from the review of the literature is the "surprise" of this unexpected complication. This factor explains the elevated mortality (2 out of 54 cases), likely due to the delay in diagnosis. The case here described is probably among the most complex published in the literature; in fact the presence of dense intra-abdominal adhesions not only contributed to the complication itself, but also explain the confinement of the hemoperitoneum to the left supra-mesocolic space and the delayed presentation (13 days from the time of the trauma).
Collapse
Affiliation(s)
- Alessandro Cappellani
- University of Catania Medical School, Policlinico, Department of Surgery, Catania, Italy
| | - Maria Di Vita
- University of Catania Medical School, Policlinico, Department of Surgery, Catania, Italy
| | - Antonio Zanghì
- University of Catania Medical School, Policlinico, Department of Surgery, Catania, Italy
| | - Andrea Cavallaro
- University of Catania Medical School, Policlinico, Fellowship in Surgical Physio-Pathology, Catania, Italy
| | - Giovanni Alfano
- University of Catania Medical School, Policlinico, Department of Surgery, Catania, Italy
| | - Gaetano Piccolo
- University of Catania Medical School, Policlinico, Department of Surgery, Catania, Italy
| | - Emanuele Lo Menzo
- University of Miami, Miller School of Medicine, Department of Surgery, Miami, Florida, USA
| |
Collapse
|
|
46
|
Abstract
INTRODUCTION Mucoceles of the appendix are infrequent entities and are found in only 0.25% of all appendectomies and 8% of all appendicular tumors. MATERIAL AND METHODS We describe 27 cases of mucocele of the appendix treated at Donostia Hospital between January 1978 and December 2006. RESULTS The mean age of the patients was 54.4 +/- 21.7 years (range: 17-88). Of the 27 patients, 15 (55.5%) were males and 12 (44.5%) were females. Emergency surgery was performed in 17 patients (62.9%). Mucoceles were identified as operative findings during surgery for other reasons in seven patients (25.9%). Three patients (11.1%) underwent surgery because of a diagnosis of abdominal tumor. The main reason for emergency surgery was lower right abdominal pain in 14 patients (82.2%), intestinal obstruction in one (5.8%), a diagnosis of endometriosis in one (5.8%) and a diagnosis of pyosalpinx in one (5.8%). Three patients underwent surgery due to pseudomyxoma peritonei after 24, 36 and 41 months' follow-up. The third patient is asymptomatic after peritonectomy and a follow-up of 78 months. We found an overall incidence of 11 cases (40.7%) presenting with synchronous or metachronous neoplasms from other locations. CONCLUSIONS We recommend monitoring of all patients with mucocele of the appendix, because these masses can sometimes be associated with neoplasms in other locations and there is a risk of pseudomyxoma peritonei even after a long follow-up.
Collapse
|
|
47
|
Cathébras P, Burnot A, Lévy M, Baccot S. Malaises à répétition dans les suites d'une coloscopie. Rev Med Interne 2007; 28:334-5. [PMID: 17275969 DOI: 10.1016/j.revmed.2006.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 12/22/2006] [Indexed: 10/23/2022]
Affiliation(s)
- P Cathébras
- Service de médecine interne, hôpital Nord, 42055 Saint-Etienne cedex 02, France.
| | | | | | | |
Collapse
|
|
48
|
Lalor PF, Mann BD. Splenic rupture after colonoscopy. JSLS 2007; 11:151-6. [PMID: 17651580 PMCID: PMC3015787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Colonoscopy is a familiar and well-tolerated procedure and is widely used as a diagnostic and therapeutic modality by both gastroenterologists and surgeons. Although perforation and hemorrhage are the most common complications, splenic injury or rupture is a rare but potentially lethal complication. We report a case of splenic rupture diagnosed 18 hours after colonoscopy, which required emergent splenectomy. We also reviewed over 39 other cases of splenic rupture or injury after colonoscopy reported in the English literature. Despite being an infrequent complication, splenic rupture warrants a high degree of clinical suspicion critical to prompt diagnosis. Most patients present with symptoms within 24 hours after colonoscopy, although delayed presentation days later has been described. CT scan of the abdomen is the radiological study of choice to evaluate colonoscopic complications. Splenic injury can be managed conservatively or with arterial embolization depending on the extent of trauma, but splenectomy remains definitive management. Clinical criteria are the primary determinants in choosing operative therapy over observation. Herein, possible risk factors for splenic trauma during colonoscopy are identified, and clinical outcomes are evaluated.
Collapse
Affiliation(s)
- Peter F Lalor
- Department of Surgery, Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
| | | |
Collapse
|
|
49
|
Leff D, Nortley M, Melly L, Bhutiani RP. Ruptured spleen following laparoscopic cholecystectomy. JSLS 2007; 11:157-60. [PMID: 17651581 PMCID: PMC3015800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy is generally a safe and well-accepted procedure. However, in a small percentage of patients, it is associated with complications, such as bleeding and injury to the bile duct and other viscera. Splenic injury as a result of laparoscopic surgery has been reported only in the context of direct trauma, for example due to retraction in hand-assisted urologic surgery. To date, there have been no reported cases of patients requiring splenectomy following laparoscopic cholecystectomy. We report an unusual case of ruptured spleen presenting less than 28 days following "uncomplicated" laparoscopic cholecystectomy. RESULTS A 52-year-old female presented to our Accident and Emergency department 3 weeks following "uncomplicated" laparoscopic cholecystectomy, complaining of severe left upper quadrant pain radiating to the left shoulder tip. Clinical examination revealed a patient in hypovolemic shock, with localized left upper quadrant peritonism. Abdominal computed tomography supported a diagnosis of splenic rupture, and the patient required an emergency splenectomy. DISCUSSION Splenic injury rarely complicates laparoscopic cholecystectomy. We postulate that either congenital or posttraumatic adhesions of the parietal peritoneum to the spleen may have caused the capsule to tear away from the spleen when the pneumoperitoneum was established, resulting in subcapsular hematoma and subsequent rupture in this patient. Videoscopic assessment of the spleen at the end of laparoscopic cholecystectomy might be a worthwhile exercise to aid early recognition and management in such cases.
Collapse
Affiliation(s)
- Daniel Leff
- Department of General Surgery, Central Middlesex Hospital, London, UK
| | | | | | | |
Collapse
|
|
50
|
Lee YT, Wu HS, Hung MC, Lin ST, Hwang YS, Huang MH. Ruptured appendiceal cystadenoma presenting as right inguinal hernia in a patient with left colon cancer: a case report and review of literature. BMC Gastroenterol 2006; 6:32. [PMID: 17074081 PMCID: PMC1634861 DOI: 10.1186/1471-230x-6-32] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2006] [Accepted: 10/30/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mucoceles resulting from cystadenomas of the appendix are uncommon. Although rare, rupture of the mucoceles can occur with or without causing any abdominal complaint. There are several reports associating colonic malignancy with cystadenomas of the appendix. Herein, we report an unusual and interesting case of right inguinal hernia associated with left colon cancer. CASE PRESENTATION A case of ruptured mucocele resulting from cystadenoma of the appendix was presented as right inguinal hernia in a 70-year-old male. The patient underwent colonoscopy, x-ray, ultrasound and computed tomography. Localized pseudomyxoma peritonei associated with adenocarcinoma of the descending colon was diagnosed. The patient underwent segmental resection of the colon, appendectomy, debridement of pseudomyxoma and closure of the internal ring of right inguinal canal. He is free of symptoms in one year follow-up. CONCLUSION Synchronous colon cancer may occur in patients with appendiceal mucoceles. In such patients, the colon should be investigated and colonoscopy can be performed meticulously in cases of ruptured mucoceles and localized pseudomyxoma peritonei. Surgical intervention is the current choice of management.
Collapse
Affiliation(s)
- Yueh-Tsung Lee
- Department of Surgery, Division of general surgery, Chang-Bing Show Chwan Memorial Hospital, Lu-Gang, Taiwan
| | - Hurng-Sheng Wu
- Department of Surgery, Division of general surgery, Chang-Hua Show Chwan Memorial Hospital, Chang-Hua, Taiwan
| | - Min-Chang Hung
- Department of Surgery, Division of general surgery, Chang-Hua Show Chwan Memorial Hospital, Chang-Hua, Taiwan
| | - Shang-Tao Lin
- Department of Pathology, Chang-Hua Show Chwan Memorial Hospital, Chang-Hua, Taiwan
| | - Yome-Shine Hwang
- Department of Surgery, Division of general surgery, Chang-Hua Show Chwan Memorial Hospital, Chang-Hua, Taiwan
| | - Min-Ho Huang
- Department of Surgery, Division of general surgery, Chang-Hua Show Chwan Memorial Hospital, Chang-Hua, Taiwan
| |
Collapse
|