SPLENIC RUPTURE - AN UNUSUAL COMPLICATION OF COLONOSCOPY

Splenic rupture is an uncommon complication of colonoscopy. A high ind ex of suspicion is a crucial factor in the prompt diagnosis of this ra re but potentially fatal complication, We report a case of splenic rup ture diagnosed 3 days after a colonoscopy and requiring splenectomy, W e also reviewed 17 reported cases of splenic rupture after colonoscopy , including our case, The presumed mechanisms of splenic rupture durin g colonoscopy are direct trauma to the spleen, excessive splenocolic l igament traction, and decrease in the relative mobility between the sp leen and the colon, Of the 17 cases reviewed, 10 had polypectomy and/o r biopsy performed during colonoscopy, Other probable risk factors are identified and tabulated, The hemodynamic status of the patient is th e primary factor used to determine the therapeutic option, Computed to mographic (CT) scan of the abdomen reliably demonstrates well-containe d splenic laceration and subcapsular hematoma, and differentiates thes e splenic complications from perisplenic clot and hemoperitoneum, Thus , CT scan may help decide which patients may be managed operatively or nonoperatively, Splenectomy is the operative procedure of choice for splenic rupture after colonoscopy. Conservative management includes br oad spectrum antibiotics, intravenous fluids, blood transfusion, and c lose hemodynamic monitoring, The factors mandating further evaluation of persistent abdominal pain after colonescopy are hemodynamic instabi lity, clinical features of acute abdomen, leukocytosis, and/or acute a nemia, The onset of abdominal pain associated with one or more of thes e critical factors is usually within 24 h after colonescopy, An emerge nt CT scan of the abdomen is the modality of choice to further evaluat e these clinical features, but intestinal perforation and external ble eding must first be excluded.