Ahmed et al developed an algorithm for evaluating patients with possible splenic rupture occurring as a complication of colonoscopy. Although rare splenic rupture needs to be treated appropriately to prevent serious complications. The authors are from Stanford and Brown Universities.


Patient selection:

(1) recent colonoscopy

(2) persistent abdominal pain present


Clinical findings to look for:

(1) acute or worsening anemia

(2) signs of an acute abdomen

(3) leukocytosis

(4) hemodynamic instability

(5) intestinal perforation

(6) source of hemorrhage that can explain the anemia


If the patient has clinical findings but no signs of intestinal perforation or a known site of hemorrhage then an abdominal CT scan is performed.


If a splenic injury is identified then it is managed either nonoperatively if minor or surgically if severe (see Chapter 29 for management of splenic trauma).


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