Colonoscopy-Induced Splenic Injury Management

Colonoscopy-induced splenic injury is a rare but potentially life-threatening complication arising from traction or direct trauma to the spleen during endoscopic advancement, particularly at the splenic flexure. Clinical presentation may be delayed, with left upper-quadrant pain, shoulder tip discomfort and hemodynamic instability emerging hours to days post procedure. Diagnosis relies on high clinical suspicion supported by imaging studies such as contrast-enhanced CT, which delineates splenic lacerations, subcapsular haematomas and intraperitoneal bleeding. Management strategies are tailored to the patient’s stability and the extent of splenic damage. In haemodynamically stable individuals with contained injuries, non-operative approaches including observation, transfusion support and serial imaging can be effective. Endovascular techniques such as superselective splenic artery embolisation have become increasingly employed to control active bleeding while preserving splenic tissue. In unstable patients or those with extensive parenchymal disruption, prompt surgical intervention—most commonly splenectomy—remains the definitive treatment. Early recognition and a multidisciplinary approach involving endoscopists, radiologists and surgeons are critical to reducing morbidity and mortality.

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Colonoscopy-Induced Splenic Injury Management publication trend

The graph below shows the total number of articles in colonoscopy-induced splenic injury management across all publications each year (not limited to Nature Index journals).

Technical terms

Splenocolic ligament: A peritoneal fold attaching the spleen to the colon, whose excessive tension during scope passage can precipitate parenchymal injury.

Haemoperitoneum: Accumulation of blood within the peritoneal cavity, often resulting from splenic laceration.

Splenectomy: Surgical removal of the spleen, indicated for uncontrollable bleeding or high-grade splenic injury.

Superselective splenic artery embolisation: Endovascular occlusion of specific branches of the splenic artery to arrest bleeding while preserving residual splenic function.

Haemodynamic stability: The state of maintaining adequate blood pressure and tissue perfusion, guiding the choice between operative and non-operative management.

References

1. Iatrogenic splenic injury: review of the literature and medico-legal issues. Open Medicine (2016).
2. Superselective splenic artery embolization for the management of splenic laceration following colonoscopy. Acta Radiologica Open (2014).