C52-48 Iatrogenic Splenic Laceration During Routine Colonoscopy With Hemorrhage Requiring Splenectomy: A Rare Complication

Abstract Introduction Colonoscopy is generally considered a safe and routinely performed diagnostic and therapeutic procedure. The most common complications include bleeding and perforation. However, splenic injury remains an infrequent and potentially fatal event. The proposed mechanisms of injury include traction on the splenocolic ligament, capsular avulsion during manipulation of the colonoscopy at the splenic flexure, or external abdominal pressure during the procedure. Because clinical symptoms can be subtle or delayed, the diagnosis may be neglected. This report presents a case of post-colonoscopy splenic rupture in a patient without identifiable predisposing factors, emphasizing the diagnosis and therapeutic challenges associated with this rare entity. The intensive care unit (ICU) plays a critical role in monitoring and guiding treatment decisions and ensuring patient stabilization. Case Presentation A 58-year-old woman with a history of transient ischemic attack, tobacco use disorder, and hyperlipidemia underwent a routine screening colonoscopy that was unremarkable. About 3.5 hours later, she developed abdominal pain radiating to the left shoulder and presented to the emergency department hypotensive (SBP 86 mmHg) with left upper quadrant tenderness and a positive Kehr’s sign. Labs showed acute anemia. CT abdomen/pelvis revealed a 4 cm subcapsular splenic hematoma with mild-moderate hemoperitoneum and active extravasation. She was resuscitated with IV fluids and packed RBCs, followed by emergent proximal splenic artery embolization and ICU admission for monitoring and management of hypoxic respiratory failure from acute blood loss anemia. Three days later, she developed worsening pain and tachycardia. Repeat CT angiography showed progression to a 9.3 × 13.2 cm perisplenic hematoma with moderate hemoperitoneum, consistent with American Association for the Surgery of Trauma (AAST) Grade V splenic injury. She underwent emergent splenectomy, confirming splenic rupture with ∼2 L hemoperitoneum. The patient recovered well postoperatively and received appropriate post-splenectomy vaccinations on her follow-up appointments. Discussion Splenic injury is a rare but potentially life-threatening complication of a colonoscopy. Symptoms typically develop within a few hours to several days following colonoscopy. The most common presentations include left upper quadrant or generalized abdominal pain, referred left shoulder pain (Kehr’s sign), hypotension, and tachycardia. Because the findings are nonspecific, splenic injury may initially be mistaken for other post-procedural complications such as colonic perforation or gastrointestinal bleeding, leading to diagnostic delay. The ICU plays a critical role in managing these patients as it enables hemodynamic observation and stabilization, early intervention for rebleeding, prompt imaging, workup, and comprehensive post-operative support. This abstract is funded by: None