Splenic Injury Following Routine Colonoscopy: A Case Report

Splenic injury is a rare but potentially life-threatening complication of colonoscopy procedures. We present the case of a 64-year-old female patient who developed an acute splenic laceration following an elective screening colonoscopy. The procedure was anatomically challenging due to colonic tortuosity but otherwise uneventful. While in the post-anesthesia care unit, the patient became hypotensive with abdominal distention and tenderness. Initial abdominal radiography was unrevealing for acute abnormalities. However, CT with intravenous contrast demonstrated hemoperitoneum secondary to a small inferior pole splenic laceration with active arterial extravasation. The patient was resuscitated with two units of packed red blood cells and treated with interventional radiology-guided angioembolization. The patient was then monitored in the surgical intensive care unit (SICU), experienced no further bleeding, and was able to be discharged home on hospital day three without further complications. This case highlights the importance of maintaining a high index of suspicion for splenic injury in patients presenting with procedures complicated by colonic tortuosity or with postoperative unexplained abdominal pain or hemodynamic instability following colonoscopy. Early recognition and prompt intervention, combined with minimally invasive management, can prevent the need for more invasive procedures, such as splenectomy, and result in favorable outcomes.