Splenic Rupture Presenting 48 Hours after Colonoscopy: A Case Report Emphasizing the Need for Prolonged Monitoring

Splenic rupture constitutes a rare yet potentially life-threatening complication following colonoscopy. We report a case of a young male patient who presented with abdominal pain for 2 days, which began 6 hours after colonoscopy. Clinical examination revealed periumbilical tenderness, with laboratory findings significant for leukocytosis (WBC: 20.32 × 10⁹/L), an initial hemoglobin of 113 g/L, and a significantly elevated D-dimer (15.25 mg/L). Abdominal computed tomography confirmed splenic rupture, perisplenic hematoma, and hemoperitoneum. Following multidisciplinary consultation involving hepatobiliary surgery and interventional radiology, the patient underwent emergent splenic artery embolization. Post-procedural management included antibiotics and supportive care. Despite achieving hemodynamic stability and symptomatic improvement, persistent leukocytosis and a significant hemoglobin decrease to 79 g/L were noted on postoperative day 1, accompanied by radiographic evidence of increased hemoperitoneum. Nonetheless, the patient remained hemodynamically stable and received ongoing supportive care, and was discharged in good condition after a hospital stay of 15 days. This case highlights the importance of maintaining a high index of suspicion for splenic injury in patients with post-colonoscopy abdominal pain, even with delayed presentation, and demonstrates the use of splenic artery embolization as a therapeutic intervention, and the need for prolonged monitoring.