History and clinical findings: A 57-year-old woman was admitted with nonspecific pain in the left upper quadrant of the abdomen, radiating to her left shoulder, starting eight hours after a prophylactic colonoscopy. Her past surgical history consisted of a pylorus-preserving partial duodenopancreatectomy for chronic pancreatitis.
Investigations: After a colon perforation had been excluded ultrasound and computed tomography revealed a covered splenic rupture.
Treatment and course: Because the patient was hemodynamically stable she was observed in the intensive care unit with hemodynamic monitoring. When the patient became hemodynamically unstable an ultrasound revealed an increase of the perisplenic fluid. She immediately had an exploratory laparotomy and the spleen wrapped in a Vicryl net. Postoperatively the patient had an uncomplicated hospital stay and was discharged on postoperative day 7.
Conclusion: Splenic rupture is a known but rare complication of colonoscopy. Early recognition and interdisciplinary management will assure successful management of this potentially life-threatening injury.