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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.
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Affiliation(s)
- Matthew Lukies
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
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2
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Abstract
Splenic rupture following colonoscopy (SRFC) is a rare complication and can have associated mortality if left undiagnosed. Most of the cases reported have been managed operatively. Here, we present a case of a 75-year-old-female who underwent conservative management for SRFC. Splenic rupture should remain a differential in patients presenting with abdominal pain, syncope, and hypotension following colonoscopy. Decisions regarding operative versus conservative management should be guided by the patient's clinical status, hemodynamics, and available resources.
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Affiliation(s)
- Nehal Ninad
- Department of Surgery, Atrium Health Navicent, Macon GA, USA
| | - Macie Edwards
- 12241Mercer University School of Medicine, Macon GA, USA
| | - Ashley Jones
- Department of Surgery, Atrium Health Navicent, Macon GA, USA
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3
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Wiggins B, Lamarche C, Gupta R, Deliwala S, Minaudo M. Splenic Injury After a Colonoscopy: Threading the Scope Carefully in Heritable Connective Tissue Disorders. Cureus 2021; 13:e15444. [PMID: 34113526 PMCID: PMC8184110 DOI: 10.7759/cureus.15444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Colonoscopies have reduced colorectal cancer (CRC) burden in the United States, and their utility has expanded to include various diagnostic and therapeutic indications. Complications are seen in up to 1% and increase with age and polypectomy. As colonoscopies become widespread, specific populations seem to be at a much higher risk; notably patients with heritable connective tissue disorders (HCTD). As life expectancy increases, these patients undergo routine screenings and require careful peri-endoscopic care to reduce adverse outcomes. Amongst HCTD, Ehlers-Danlos syndrome (EDS) is commonly implicated, however, no reports of Marfan syndrome (MS) exist. We present a unique case of splenic injury after colonoscopy in a patient with MS. Successful outcomes require early suspicion and emergent surgical evaluation in patients with hemodynamic instability after a colonoscopy. Increased ligament laxity and bowel fragility are the most likely mechanisms. Alternative CRC strategies like fecal immunochemical test (FIT), fecal occult, Cologuard, or virtual colonography can be considered.
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Affiliation(s)
- Brandon Wiggins
- Internal Medicine, Ascension Genesys Hospital, Grand Blanc, USA
| | - Cassandra Lamarche
- School of Medicine, Michigan State University College of Human Medicine, East Lansing, USA
| | - Rohit Gupta
- Internal Medicine/Pediatrics, Michigan State University, Flint, USA
| | - Smit Deliwala
- Internal Medicine, Michigan State University at Hurley Medical Center, Flint, USA
| | - Mark Minaudo
- Gastroenterology and Hepatology, Ascension Genesys Hospital, Grand Blanc, USA
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4
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Liu J, Ladde J. Splenic Laceration Post Colonoscopy: A Rare Complication. J Emerg Med 2020; 59:e61-e63. [PMID: 32600886 DOI: 10.1016/j.jemermed.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/13/2020] [Accepted: 05/07/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The number of colonoscopies performed in the United States is increasing each year. Although the procedure is generally safe and effective, complications can arise. Splenic laceration is an extremely rare complication of colonoscopy. CASE REPORT A 71-year-old woman presented to the Emergency Department with abdominal pain and left shoulder pain accompanied by nausea within 24 h of undergoing a colonoscopy. A computed tomography scan showed hemoperitoneum, with findings suggestive of a splenic laceration. Upon laparoscopy, the patient was found to have a splenic laceration with active bleeding. She was treated with splenectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Colonoscopy is one of the most commonly performed outpatient procedures in the United States. As such, being able to recognize potential complications of the procedure is essential. With the number of colonoscopies being performed each year increasing, the emergency physician should be aware of the remote possibility of splenic injury as a cause of abdominal pain whenever a history of recent colonoscopy is elicited from the patient.
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Affiliation(s)
- Jonathan Liu
- University of Central Florida College of Medicine, Orlando, Florida
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5
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Zhang AN, Sherigar JM, Guss D, Mohanty SR. A delayed presentation of splenic laceration and hemoperitoneum following an elective colonoscopy: A rare complication with uncertain risk factors. SAGE Open Med Case Rep 2018; 6:2050313X18791069. [PMID: 30083323 PMCID: PMC6066810 DOI: 10.1177/2050313x18791069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/05/2018] [Indexed: 12/19/2022] Open
Abstract
Splenic laceration is a rare yet often underreported complication of colonoscopy
that is infrequently discussed with the patient during the consent process. Most
cases present within 48 h after the inciting colonoscopy; a delayed presentation
is rare. We present a case of splenic laceration with hemoperitoneum that
manifested 5 days after the initial colonoscopy. The patient was treated
conservatively. Traditionally perceived risk factors such as intra-abdominal
adhesions, splenomegaly, anticoagulation use, biopsy, polypectomy, a technically
challenging procedure, and anesthesia assistance have not been clearly shown to
increase the incidence of splenic injury following a colonoscopy. Since the risk
factors of splenic injury remain unclear, the clinical presentation is
nonspecific, and the consequences can be serious, the endoscopist should make an
effort to inform the patient of this rare complication before the procedure.
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Affiliation(s)
- Allison N Zhang
- Division of Gastroenterology and Hepatobiliary Diseases, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Jagannath M Sherigar
- Division of Gastroenterology and Hepatobiliary Diseases, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Debra Guss
- Division of Gastroenterology and Hepatobiliary Diseases, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Smruti R Mohanty
- Division of Gastroenterology and Hepatobiliary Diseases, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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6
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Nallayici EG, de Groot R, van Zanten RAA, Lutke Holzik MF. Shock due to Splenic Injury after Colonoscopy. Case Rep Gastroenterol 2017; 11:127-133. [PMID: 28611565 PMCID: PMC5465718 DOI: 10.1159/000455940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/03/2017] [Indexed: 12/16/2022] Open
Abstract
Colonoscopy is a common and increasingly performed procedure. It is used both as a diagnostic and therapeutic modality. Splenic injury after colonoscopy is a rare, yet life-threatening complication, most often caused by traction on the splenocolic ligament or excessive manipulation during the procedure. Although non-operative treatment is preferred upon splenic injury, early surgical or radiological intervention may be necessary in specific cases, for example in case of haemodynamic instability. A 71-year-old Caucasian man was referred to our emergency room due to shock after colonoscopy 2 days earlier. A computed tomography scan showed splenic rupture with active intra-abdominal, venous blood loss, and microperforation of the colon. An immediate splenectomy and colon repair were performed through laparotomy. After 6 days, the patient was discharged from hospital in good health. Although splenic rupture is a rare complication of colonoscopy, patients with abdominal pain and/or shock should be checked for complications such as splenic injury and colon perforation.
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Affiliation(s)
- Erol G Nallayici
- aDepartment of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo, the Netherlands
| | - Reinier de Groot
- aDepartment of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo, the Netherlands
| | - René A A van Zanten
- bDepartment of Gastroenterology, Ziekenhuisgroep Twente (ZGT), Almelo, the Netherlands
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7
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The role of surgery in the treatment of endoscopic complications. Best Pract Res Clin Gastroenterol 2016; 30:841-851. [PMID: 27931640 DOI: 10.1016/j.bpg.2016.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/05/2016] [Accepted: 10/02/2016] [Indexed: 01/31/2023]
Abstract
As the number, diversity, and complexity of endoscopic complications has increased, so too has the number, diversity, and complexity of operative interventions required to treat them. The most common complications of endoscopy in general are bleeding and perforation, but each endoscopic modality has specific nuances of these and other complications. Accordingly, this review considers the surgical complications of endoscopy by location within the gastrointestinal tract, as opposed to by complication types, since there are many complication types that are specific for only one or few locations, such as buried-bumper syndrome after percutaneous endoscopic gastrostomy and pancreatitis after endoscopic retrograde cholangiopancreatography, and since the management of a given complication, such as perforation, may be vastly different in one area than in another area, such as perforations of the esophagus versus the retroperitoneal duodenum versus the intraperitoneal duodenum. It is hoped that this review will provide guidance for gastroenterologists considering a particular procedure, either to assess the risks for surgical complications in preparation for patient counseling, or assist in assessing a patient who seems to be having a severe complication, or to learn what operation might be required to treat a given complication and how that operation might be performed. As with many operations, those for the treatment of endoscopic complications are typically performed only when less invasive, nonoperative strategies fail.
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8
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Lahat E, Nevler A, Batumsky M, Shapiro R, Zmora O, Gutman M. Diagnosis and management of splenic injury following colonoscopy: algorithm and case series. Tech Coloproctol 2016; 20:163-9. [PMID: 26757901 DOI: 10.1007/s10151-015-1422-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/30/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Splenic injury following colonoscopy is a rare yet life-threatening complication. These injuries are often associated with delayed diagnosis and may require invasive intervention. We sought to study the emergent presentation associated with splenic injury post-colonoscopy and to suggest a new treatment algorithm. METHODS Six cases of splenic injury following colonoscopy were collected from three medical centers. Data regarding patient medical history, clinical presentation, laboratory and imaging findings and clinical management were recorded. A systematic PubMed/MEDLINE search was performed. Non-English-language publications and publications dating earlier than 2010 were excluded. An emergency department trauma-based management algorithm was designed according to the identified publications and review of the available trauma literature. RESULTS The mean age was 65.3 years and the male-to-female ratio was 1:5. Five of the cases presented within 24 h of the colonoscopy complaining of severe abdominal pain. Hemodynamic instability was noted in four patients who presented with tachycardia (105-130), hypotension and/or a rapid drop in hemoglobin levels. All of the patients underwent initial resuscitation and a computerized abdominal tomography scan. Four of them required emergent splenectomy. No mortality or major morbidity was reported following the hospitalization. CONCLUSIONS Although very rare, splenic injury during colonoscopy is an acute, severe and possible fatal complication. Patients may present with a rapid clinical deterioration and hemodynamic instability. Physicians should be familiar with the practical management of this surgical emergency and the treatment options available.
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Affiliation(s)
- E Lahat
- Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel
| | - A Nevler
- Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel.
- The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
| | - M Batumsky
- Department of Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - R Shapiro
- Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - O Zmora
- Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel
| | - M Gutman
- Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel
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9
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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: 3.8] [Reference Citation Analysis] [Abstract] [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.
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10
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11
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Brennan IM, Faintuch S, Sacks B. Superselective splenic artery embolization for the management of splenic laceration following colonoscopy. Acta Radiol Short Rep 2014; 3:2047981614524199. [PMID: 25298862 PMCID: PMC4184410 DOI: 10.1177/2047981614524199] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 01/24/2014] [Indexed: 12/17/2022] Open
Abstract
Splenic injury is a rare complication following colonoscopy with fewer than 100 reported cases worldwide to date. We describe a case of splenic laceration presenting 5 days following diagnostic colonoscopy. Although hemodynamically stable, active contrast extravasation on contrast-enhanced multidetector computed tomography predicted likely failure of conservative management. Splenic artery angiography confirmed active extravasation from the lower splenic pole and the patient was successfully treated with super selective coil embolization of a lower pole splenic artery branch. This is the eighth reported case of endovascular treatment of splenic injury following colonoscopy. To our knowledge, however, superselective splenic artery embolization has not been previously reported to treat this rare endoscopic complication.
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Affiliation(s)
- Ian M Brennan
- Section of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Salomao Faintuch
- Section of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Barry Sacks
- Section of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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12
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Lauretta A, Busuito G, Bellomo RE. Splenic Injury during Colonoscopy: A Complication Hardly Thought Hence Hardly Sought. Am Surg 2014. [DOI: 10.1177/000313481408000405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andrea Lauretta
- Division of General Surgery Santa Maria dei Battuti Hospital San Vito al Tagliamento, Italy
| | - Giovanna Busuito
- Division of General Surgery Santa Maria dei Battuti Hospital San Vito al Tagliamento, Italy
| | - Roberto Enrico Bellomo
- Division of General Surgery Santa Maria dei Battuti Hospital San Vito al Tagliamento, Italy
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13
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Abstract
Colonoscopy is a relatively invasive modality for the diagnosis and treatment of colorectal disease and for the prevention or early detection of colorectal neoplasia. Millions of colonoscopies are performed each year in the United States by endoscopists with varying levels of skill in colons that present varying levels of challenge. Although better scope technology has made colonoscopy gentler and more accurate, the sheer number of examinations performed means that complications inevitably occur. This article considers the most common complications of colonoscopy, and advises how to minimize their incidence and how to treat them if they do occur.
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14
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Guner A, Kaya U, Kece C, Kucuktulu U. Is non-operative management feasible for splenic injury due to colonoscopy? BMJ Case Rep 2013; 2013:bcr-2013-009286. [PMID: 23774704 DOI: 10.1136/bcr-2013-009286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Colonoscopy is a widely used diagnostic and therapeutic procedure. While it is a relatively safe procedure, there is a risk of some complications. Splenic injury after colonoscopy is a very rare but a life-threatening complication; around 105 cases have been reported in the literature so far. Owing to the rarity of this complication, no management standards were defined. In the literature, most of the patients were managed with operative intervention and less frequently with observation. We report a case of splenic injury and massive hemoperitoneum due to colonoscopy treated non-operatively.
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Affiliation(s)
- Ali Guner
- Department of General Surgery, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
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Affiliation(s)
- Lucas Pineda
- Columbia University/Harlem Hospital Center New York, New York
| | - Mohammad Sarhan
- Columbia University/Harlem Hospital Center New York, New York
| | - Paritosh Suman
- Columbia University/Harlem Hospital Center New York, New York
| | | | - Antonio Chua
- Woodhull Medical and Mental Health Center and Columbia University/ Harlem Hospital Center New York, New York
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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: 1.4] [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.
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Affiliation(s)
- Antonella Corcillo
- Département de Médecine Interne, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,
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17
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Abstract
BACKGROUND Delayed splenic rupture (DSR) is a rare manifestation of blunt splenic trauma, and splenectomy remains the primary treatment for patients with DSR. The purpose of this study was to review our experience with nonsurgical management of DSR with the use of splenic artery embolization (SAE) as an adjunct treatment. METHODS This retrospective study included patients with DSR treated at our institution from January 2001 to December 2008. Management included initial resuscitation and close observation in the intensive care unit. Further interventions were based on the patient's hemodynamic status and followed a treatment protocol. These interventions included SAE or surgery. RESULTS There were 15 patients included in the analysis. Three patients underwent emergent surgery, and 12 patients received nonsurgical management initially. Of these 12 patients, five underwent SAE. One of these five patients subsequently underwent splenectomy because of recurrent bleeding. Of the remaining seven patients who received nonoperative management, one required a splenectomy because of recurrent hemorrhage and hypotension. There were no mortalities; however, two surgery-associated complications occurred. The success rate of nonsurgical therapy was 83%. SAE was used for splenic salvage with a success rate of 80% (4 of 5). The overall failure rate of DSR was 33% (5 of 15). CONCLUSIONS Nonsurgical management can safely be used in selected patients with DSR, especially for those with a good response to resuscitation. SAE is as effective for DSR as it is for acute splenic injury. Physicians should consider SAE as an option for the treatment of DSR.
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18
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Milzverletzung im Rahmen einer Koloskopie mit tödlichem Verlauf. Rechtsmedizin (Berl) 2012. [DOI: 10.1007/s00194-011-0804-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The frequency of endoscopic complications is likely to rise owing to the increased number of indications for therapeutic procedures and also to the increased complexity of endoscopic techniques. Informed patient consent should be obtained as part of the procedure. Prevention of endoscopic adverse events is based on knowledge of the relevant risk factors and their mechanisms of occurrence. Thus, suitable training of future gastroenterologists and endoscopists is required for these complex procedures. When facing a complication, appropriate management is generally provided by an early diagnosis followed by prompt therapeutic care tailored to the situation. The most common complications of diagnostic and therapeutic upper gastrointestinal endoscopy, retrograde cholangiopancreatography, small bowel endoscopy and colonoscopy are reviewed here. Different modalities of medical, endoscopic or surgical management are also considered.
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Affiliation(s)
- Daniel Blero
- ISPPC, 1 Boulevard Zoé Drion, 6000 Charleroi, Belgium.
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20
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Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA. Complications of colonoscopy. Gastrointest Endosc 2011; 74:745-52. [PMID: 21951473 DOI: 10.1016/j.gie.2011.07.025] [Citation(s) in RCA: 234] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 07/15/2011] [Indexed: 12/17/2022]
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