Splenic rupture may occur during colonoscopy and can result in intra-peritoneal hemorrhage.


Risk factors for splenic rupture:

(1) risk factors for splenocolic adhesions:

(1a) previous abdominal surgery

(1b) pancreatitis

(1c) inflammatory bowel disease

(2) direct trauma to the spleen by the colonoscope

(3) splenomegaly

(4) underlying splenic disease

(5) taking a biopsy from along the distal transverse colon to the proximal descending colon


Clinical findings:

(1) hemodynamic instability

(2) abdominal pain (either left upper quadrant or lower abdominal pain)

(3) pain radiating to the left shoulder (Kehr's sign; by itself it is nonspecific)

(4) extravasation of contrast material from the spleen on CT scan

(5) no evidence of bowel perforation or free air in the abdomen


Onset of symptoms may be from hours to days after the procedure.


To read more or access our algorithms and calculators, please log in or register.