A Case of Iatrogenic Splenic Injury Following Routine Colonoscopy With Possible Influence of Unique Anatomy Due to Severe Scoliosis

Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

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.

Splenic Injury: A Curious Complication of Colonoscopy

Colonoscopies are generally considered a safe procedure with an overall complication rate of 0.5%. Splenic injuries, including laceration, subcapsular hematoma, and rupture, have been thought to be underreported in the currently available literature. The etiology of splenic injury remains unknown, although excessive splenocolic ligament stretching and traction of adhesions have been hypothesized to play a role in its development. Even though conservative, percutaneous, and surgical strategies have been described in the literature, these strategies have been associated with higher mortality, and there is no consensus on the optimal approach to management. We present the case of a patient who sustained a splenic injury after a colonoscopy and was successfully managed with conservative measures.