Endoscopy 2008; 40(1): 76-79
DOI: 10.1055/s-2007-966940
Case report

© Georg Thieme Verlag KG Stuttgart · New York

Splenic injury after colonoscopy

C.  R.  Petersen1 , S.  Adamsen2 , P.  Gocht-Jensen2 , R.  B.  Arnesen1 , O.  Hart-Hansen1
  • 1The Patient Insurance Association, Copenhagen, Denmark
  • 2Department of Gastrointestinal Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
Further Information

Publication History

submitted 2 January 2007

accepted after revision 6 August 2007

Publication Date:
04 December 2007 (online)

Splenic injury is a rare and serious complication of colonoscopy. The most likely mechanism is tension on the splenocolic ligament and adhesions. Eight cases were identified among claims for compensation submitted to the Danish Patient Insurance Association during the period 1992-2006, seven of which were reported after 2000. The total number of colonoscopies in Denmark in 2004 was 39 067. Seven of the eight patients were aged 65 years or over. Loops causing difficulties during the colonoscopy had been reported in four patients. All the patients had a symptom-free interval after the colonoscopy, ranging from 4 hours to 7 days, before presenting with signs of splenic injury. In all cases the spleen was torn, and the amount of blood in the peritoneal cavity ranged from 1500 mL to 5000 mL. Two patients died postoperatively. The number of cases reported after 2000 indicates that this potentially lethal complication might be more common than was previously assumed, and it is possibly under-reported. Preventive measures include good colonoscopic technique to avoid loop formation and the use of excessive force; and it is possible that emerging endoscopic technologies will lead to a reduced risk of splenic injury. The information given to patients both before and after the procedure should include information on the signs of this complication, and patients should be also informed that these signs can develop after a symptom-free interval.

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S. Adamsen, MD, FASGE 

Department of Gastrointestinal Surgery D

Copenhagen University Hospital Herlev

75 Herlev Ringvej

Herlev DK-2730

Denmark

Fax: +45-4488-4009

Email: vad@heh.region.dk

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