Splenic Injuries Due to Colonoscopy in Adult Out-Patients-A Registry-Based Study

The incidence of splenic injuries due to colonoscopy is largely unknown but seems to be substantial in hospitalized patients. The risk may be lower in out-patients.

The incidence, risk factors, and outcome of splenic lesions was studied in 1.44 million cases with a complete out-patient colonoscopy.

Using an administrative data base of a health insurance company with 11 million insured subjects, patients undergoing out-patient colonoscopy associated with a splenic injury within 7 days were retrieved from the records based upon OPS and EBM (comparable to ICPM) and ICD-10 codes. In each case identified (n = 163), the clinical course was reconstructed by 2 physicians. Patients with other causes of splenic injuries (abdominal surgery, trauma etc.) were excluded.

Among 1,443,341 total colonoscopies in out-patients over a 5-year period, 46 splenic lesions were most likely solely due to colonoscopy. This accounts for 3.19 splenic injuries per 100,000 colonoscopies or 1 lesion in 31,400 patients. Afflicted patients were more likely to be female (relative risk: 1.7) than male. Surgical interventions were carried out in 19 cases (41%), predominantly splenectomy (n = 17), whereas 27 events (59%) were managed conservatively. Transfusions and intensive care treatment were predictors for the need of surgery. Most lesions (63%) were diagnosed within 48 h after colonoscopy.

Administrative data analysis suggests that splenic Injuries due to colonoscopy are less frequent compared to hospitalized patients. Endoscopists should be aware of this rare and life-threatening adverse event.