Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2020; 12(2): 55-67
Published online Feb 27, 2020. doi: 10.4240/wjgs.v12.i2.55
Splenic injuries secondary to colonoscopy: Rare but serious complication
Waqas Ullah, Mamoon Ur Rashid, Asif Mehmood, Yousaf Zafar, Ishtiaq Hussain, Deepika Sarvepalli, Muhammad Khalid Hasan
Waqas Ullah, Department of Internal Medicine, Abington Hospital, Abington, PA 19001, United States
Mamoon Ur Rashid, Deepika Sarvepalli, 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
Muhammad Khalid Hasan, Department of Gastroenterology, Advent Health Hospital, Orlando, FL 32804, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mamoon Ur Rashid, MBBS, MD, Doctor, Medical Resident, Department of Internal Medicine, Advent Health Hospital, 2501 North Orange Avenue, Orlando, FL 32804, United States. mamoon.rashid.md@adventhealth.com
Received: September 6, 2019
Peer-review started: September 6, 2019
First decision: September 28, 2019
Revised: November 23, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: February 27, 2020
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.

Keywords: Colonoscopy, Spleen, Splenic rupture, Systematic review, Splenic injuries

Core tip: Colonoscopy is a safe diagnostic and therapeutic procedure for evaluation of large bowel diseases. Rarely, a splenic Injury can occur. We perform a structured search on four databases and selected 45 articles with 68 patients. The reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients were identified and analyzed. 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. 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.