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Updated: Mar 12, 2026

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Hemoperitoneum as a Consequence of Colonoscopy.

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Colonoscopy rarely causes hemoperitoneum without organ damage. This case highlights bleeding from a ruptured portal-caval collateral vessel in a cirrhotic patient, not splenic rupture.

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Area of Science:

  • Gastroenterology
  • Hepatology
  • Interventional Endoscopy

Background:

  • Hemoperitoneum, or blood in the peritoneal cavity, is an uncommon complication of colonoscopy.
  • It is typically associated with splenic rupture due to traction on the splenocolic ligament.
  • Patients with liver cirrhosis have altered splanchnic vasculature, increasing the risk of bleeding complications.

Observation:

  • A 48-year-old male with liver cirrhosis presented with hemoperitoneum following a diagnostic colonoscopy for iron deficiency anemia.
  • The patient exhibited no signs of splenic damage or colon perforation.
  • Computed tomography revealed no evidence of organ injury but suggested a ruptured portal-caval collateral vessel as the bleeding source.

Findings:

  • This case demonstrates a rare instance of hemoperitoneum post-colonoscopy without splenic or colon injury.
  • The likely etiology was attributed to the rupture of a portal-caval collateral vessel, a finding supported by imaging.
  • This challenges the conventional understanding of colonoscopy-induced hemoperitoneum.

Implications:

  • Highlights the importance of considering collateral vessel rupture in cirrhotic patients undergoing colonoscopy.
  • Suggests a need for heightened vigilance for non-splenic bleeding sources in this patient population.
  • May influence procedural protocols and post-colonoscopy monitoring in patients with portal hypertension.