Death due to a rare complication of colonoscopy and the potential medicolegal implications

Area of Science:

• Gastroenterology
• Pathology
• Medical Imaging

Background:

• Screening colonoscopy is a vital procedure for colorectal cancer prevention.
• Complications, though rare, can occur and require thorough understanding.
• Nontraumatic splenic capsule avulsion is a recognized but infrequently reported complication.

Observation:

• A 64-year-old female presented with fatal hemoperitoneum post-colonoscopy.
• Autopsy revealed 1.9 L of blood in the abdominal cavity.
• The sole significant finding was a nontraumatic splenic capsule avulsion.

Findings:

• Splenic capsule avulsion was identified as the cause of severe hemoperitoneum and death.
• The mechanism is theorized to involve excessive traction on the splenocolic ligament during colonoscopy.
• Patients typically present within 24 hours with nonspecific symptoms, potentially delaying medical attention.

Implications:

• This case underscores the critical need for heightened awareness of splenic capsule avulsion as a rare but severe colonoscopy complication.
• Reporting such cases is crucial for improving diagnostic vigilance and patient safety.
• Further research may elucidate optimal preventative strategies and diagnostic criteria for this complication.