Splenic injury complicating therapeutic upper gastrointestinal endoscopy and ERCP

Splenic subcapsular hematoma following endoscopic retrograde cholangiopancreatography: A case report and review of literature

BACKGROUND

Splenic injury following endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication. The literature contains around 30 articles reporting various degrees of splenic injuries resulting from ERCP since the first report of splenic rupture after ERCP in 1989.

CASE SUMMARY

This report describes a case of splenic hematoma and stent displacement in a 69-year-old male patient who developed these conditions 7 days after undergoing ERCP and stenting. The patient had bile duct stenosis caused by a malignant tumor that was obstructing the bile duct. The diagnosis was confirmed by epigastric computed tomography and magnetic resonance cholangiopancreatography. The patient was successfully treated with percutaneous transhepatic cholangial drainage, endoscopic pyloric stent placement, and conservative management. The causes of splenic injury following ERCP are discussed.

CONCLUSION

ERCP has the potential to cause splenic injury. If a patient experiences symptoms such as abdominal pain, decreased blood pressure, and altered hematology after the procedure, it's important to be thoroughly investigated for postoperative bleeding and splenic injury.

Endoscopic retrograde cholangiopancreatography induced splenic injury: comprehensive analysis and new perspectives based on a case report

Splenic injury is an extremely rare complication of endoscopic retrograde cholangiopancreatography (ERCP). There are only 34 cases reported in the literature up to now. Based on a case of a 72-year-old man, who after ERCP due to choledocholithiasis developed a large perisplenic and subcapsular hematoma, we carried out an extensive review of all cases of ERCP-induced splenic injury found in the literature. We searched PubMed/Medline and Google Scholar till 15 April 2023, for published case reports and series using the following terms: splenic injury after ERCP, ERCP-induced splenic injury, and post-ERCP splenic trauma. The case reports included were in English, Spanish, and German literature. We attempt to discuss the possible clinical image, the available diagnostic methods, the potential treatment alternatives, and predisposing factors related to this entity. Furthermore, a theory of a possible mechanism of this injury is discussed and supported schematically. The ERCP-induced splenic injury is rare and a high index of suspicion is needed for diagnosis. Therefore, we present two diagnostic algorithms, which according to our opinion may assist the evaluation of this complication and lead to early accurate diagnosis and appropriate management. Collectively, our findings support that although ERCP-induced splenic injury is an unexpected/unusual complication of ERCP, following the proper steps can be timely diagnosed and treated.

Splenic Subcapsular Hematoma After Endoscopic Retrograde Cholangiopancreatography

The complications of endoscopic retrograde cholangiopancreatography (ERCP) are numerous and mainly intraluminal. We present a unique case of a patient who developed splenic hematoma after ERCP. A 41-year-old woman was hospitalized for evaluation of chronic abdominal pain, for which she underwent an ERCP. The next day, the patient developed hemorrhagic shock. She was found to have a large ruptured subcapsular splenic bleed. Splenic artery embolization was performed, and the patient was stabilized. In conclusion, a high index of suspicion should be kept when managing patients presenting with unstable vital signs and/or acute anemia after ERCP.

Splenectomy post-splenic injury following dilatation of Roux-en-y enterostomy stomal stricture: an unexpected complication

A 53-year-old woman presented in the early hours of the morning with generalised abdominal pain and features of hypovolaemic shock, following a dilatation of an enterostomy stricture 12 hours prior. Dilatation of this stricture was indicated by ongoing dysphagia, which had been successfully dilated twice before without incident. Standard resuscitative measures and confirmation of the endoscopically-caused splenic injury by CT scan were followed promptly by a splenectomy to control ongoing blood loss. The strictured enterostomy was revised to mitigate further need for endoscopic dilatation. The patient recovered well and was discharged shortly after on a soft diet.

A Very Rare Cause of Splenic Injury: Splenic Hematoma Following a Diagnostic Upper Endoscopy (Esophagogastroduodenoscopy) and Biopsy of Gastric Ulcer

The potential for splenic injury from esophagogastroduodenoscopy (EGD) is exceptionally low. To our knowledge, less than five cases have been reported in literature. Though still uncommon, splenic rupture due to diagnostic or therapeutic procedures is more frequently described following colonoscopy and endoscopic retrograde cholangiopancreatography. We report a 62-year-old Caucasian male with primary squamous cell carcinoma of the lung who presented 2 days after an EGD and gastric ulcer biopsy. The patient complained of severe left upper quadrant abdominal pain with rebound tenderness. Upon further evaluation, a diagnosis of a large subcapsular splenic hematoma was made with computed tomography (CT) imaging. The mechanism of splenic injury attributable to EGD is traction on the greater curvature of the stomach, causing avulsion of the splenic or short gastric vessels. We feel this case represents a very rare yet serious complication of EGD that warrants consideration and further investigation.

Endoscopic Retrograde Cholangiopancreatography-Induced Splenic Injury in a Patient With Sleeve Gastrectomy

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure with significant complications. Splenic hematoma is an extremely rare but known complication following ERCP that has been increasingly reported in the past several years. We report the case of a 44-year-old patient with a history of sleeve gastrectomy who underwent an ERCP that was complicated by both acute pancreatitis and splenic hematoma. She was managed conservatively under close monitoring in the intensive care unit. Clinicians should be aware of this potentially life-threatening complication to make a prompt diagnosis and begin early appropriate management.

Splenic Injury Following Endoscopic Retrograde Cholangiopancreatography: A Case Report and Literature Review

Splenic injury following endoscopy is a rare but potentially fatal complication. While this has been found to occur more frequently after colonoscopy, splenic injury following endoscopic retrograde cholangiopancreatography (ERCP) remains highly uncommon since its first reported case in 1989. Indeed, there have been only 19 such cases reported in the English, German, and Spanish literature collectively over the past 27 years. We report on a 59-year-old woman who developed a peri-splenic haematoma diagnosed on abdominal computed tomography the day following ERCP and stenting for Mirizzi syndrome. The patient was treated conservatively and made a full recovery. We reviewed all cases of post-ERCP splenic injuries reported to date and discuss the published opinions on the likely mechanism of injury, predisposing factors, presenting features, investigation, and treatment options. Ultimately, patient outcome relies on clinical suspicion of this rare complication following ERCP.

Splenic Subcapsular Hematoma After Endoscopic Retrograde Cholangiopancreatography in a Liver Transplant Recipient: Case Report and Literature Review

Splenic injuries after an endoscopic retrograde cholangiopancreatography are a rare but lethal complication. We describe a subcapsular splenic hematoma requiring emergent splenectomy after an endoscopic retrograde cholangiopancreatography in a liver transplant recipient.

Splenic Avulsion Following PEG Tube Placement: A Rare but Serious Complication

Placement of a percutaneous endoscopic gastrostomy (PEG) tube is a common procedure to allow for enteral nutrition in patients with multiple indications. PEG tube placement is a safe procedure with minor complications such as site infection and irritation. One of the more severe complications is splenic laceration, which may result in intra-peritoneal bleeding and manifest as an acute abdomen. We present a rare case of intra-abdominal bleeding secondary to catastrophic splenic injury 12 hours after PEG tube placement resulting in hemodynamic compromise. The patient underwent splenectomy and had an uneventful recovery.

Delayed Presentation of Splenic Rupture After Endoscopy in a Patient With Hemophilia A: Case Report and Review of the Literature

An 88-year-old female presented with dyspnea on exertion and severe anemia. Colonoscopy was unremarkable and the patient was transfused with packed red blood cells prior to discharge. The patient returned 2 weeks later with severe abdominal pain, hypotension, and anemia. Computed tomography revealed splenic hematoma and hemoperitoneum. She bled from the surgical sites during emergent splenectomy and work-up revealed hemophilia A. We present, to our knowledge, a case of the longest reported delay in presentation of post-colonoscopy splenic rupture and the first in a patient with hemophilia A.

Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) has become a primary tool for the treatment of biliary and pancreatic ductal diseases. It is essential for the endoscopist carrying out the ERCP to have a thorough understanding of the potential adverse events. Typically, endoscopists are well familiar with common adverse events such as post-ERCP pancreatitis, cholangitis, post-sphincterotomy bleeding, post-sphincterotomy perforation, and sedation-related cardiopulmonary compromises. However, there are other less common adverse events that arecritical to promptly recognize in order to provide appropriate therapy and prevent disastrous outcomes. This review focuses on the presentation and management of the less common and rare adverse events of an ERCP from the perspective of the practicing endoscopist.

613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

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.

Splenic decapsulation after gastroscopy

Sanguineous splenic complications in elective treatment procedures remain a potentially life-threatening complication in patients of all age groups. In this case, the patient, as per her past medical history, underwent a laparoscopic appendectomy when she was admitted to the clinic. One of the diagnostic procedures to find the reason for the epigastric pain, a gastroscopy, can retrospectively be held responsible for decapsulation of the spleen.

Splenic Injury and ERCP: A Possible Risk for Patients with Advanced Chronic Pancreatitis

Splenic injury is a rare but potentially life-threatening complication of endoscopy, with very few cases of endoscopic retrograde cholangiopancreatography (ERCP)-induced injury reported in the literature. Here we report a patient with chronic alcoholic pancreatitis who was diagnosed with a sub-capsular splenic laceration nearly 6 days after an ERCP. Clinicians should be alerted to the potential post-procedure complications associated with ERCP, particularly as this procedure is being utilized more frequently for the management of patients with complex hepatobiliary and pancreatic conditions.

Splenic rupture following a diagnostic upper endoscopy

Complications following endoscopic procedures have been rarely reported and spontaneous rupture of a normal spleen is an exceptional complication following a gastroscopy. This paper reports a case of a spontaneous rupture of a normal spleen following a gastroscopy.

[Subcapsular hepatic hematoma after endoscopic retrograde cholangiopancreatography: case report and literature review]

Subcapsular hepatic hematoma is a rare complication of endoscopic retrograde cholangiopancreatography. The mechanism of this lesion has not been clearly established. The following observation clarifies the physiopathology, as well as providing a review of the various cases described in the literature.

Plasmapheresis and corticosteroid treatment for persistent jaundice after successful drainage of common bile duct stones by endoscopic retrograde cholangiography

Prolonged cholestasis is a very rare complication of endoscopic retrograde cholangiography (ERC). Only few cases with this complication are reported in the English literature. We report persisting cholestatic jaundice in a 73-year old man after successful therapeutic ERC for choledocholithiasis. Serologic tests for viral and autoimmune hepatitis were all negative. A second-look ERC was normal also. He denied any medication except for prophylaxis given intravenous 1 g ceftriaxon prior to the ERC procedure. After an unsuccessful trial with ursodeoxycholic acid and cholestyramine for 2 wk, this case was efficiently treated with corticosteroids and plasmapheresis. His cholestatic enzymes became normal and intense pruritis quickly resolved after this treatment which lasted during his follow-up period. We discussed the possible mechanisms and treatment alternatives of intrahepatic cholestasis associated with the ERC procedure.

Splenic Injury: A Rare Complication of Endoscopic Retrograde Cholangiopancreatography

Splenic injury is an extremely rare complication after endoscopic retrograde cholangiopancreatography (ERCP); to our knowledge, only seven such cases have previously been reported in the literature. Though the mechanism of splenic injury after ERCP is unclear, “bowing” of the endoscope in the “long position” with torsion on the greater curvature of the stomach may lead to splenic vascular or capsular avulsion. Other contributing factors potentially include excessive manipulation of the duodenoscope (particularly with difficulty cannulating the ampulla of Vater or common bile duct), excessive manipulation of the patient during the procedure, or the presence of intra-abdominal adhesions. As ERCP is being employed more frequently for the diagnosis and treatment of pancreatico-biliary disease, clinicians must be aware of this rare but potentially lethal complication to allow for early accurate diagnosis and therapy.

Complications of endoscopic retrograde cholangiopancreatography: spectrum of abnormalities demonstrated with CT

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure that is performed to diagnose and treat pancreatic and biliary disease. In approximately 5%-10% of cases, the procedure itself causes adverse events. Diagnosis and management of ERCP-induced complications are performed with clinical, laboratory, and radiologic procedures. Evaluation of the type and severity of the complication is necessary and is successfully performed with computed tomography (CT). The most common causes of post-ERCP pain are acute pancreatitis and duodenal perforation. In severe pancreatitis, the pancreas is enlarged and enhances heterogeneously at CT. Pancreatic enhancement is diminished in areas of glandular necrosis. In duodenal perforation, CT may reveal extraluminal air or fluid. CT findings of acute duodenal hemorrhage are duodenal wall thickening and a high-attenuation mass in the duodenal wall. In infection, the bile ducts can be dilated and the attenuation of the bile can be increased at CT. Abscesses appear as hypoattenuating masses with enhancing capsules. CT findings of stent migration are an atypical location of the stent and bowel impaction. Other complications of ERCP are those related to endoscopy and include esophageal, liver, and splenic injury.

Splenic trauma following endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is a safe diagnostic and therapeutic procedure. Splenic injury after ERCP is extremely rare and only two cases have been reported in the English literature. A subcapsular splenic hematoma is reported after ERCP and the mechanism of injury and possible preventive measures are discussed.

Splenic injury and abscess complicating endoscopic retrograde cholangiopancreatography

A subcapsular hematoma of the spleen was incurred during ERCP and papillotomy. This was complicated by development of a splenic abscess, which was treated by percutaneous drainage.