Post-colonoscopic splenic rupture and hemorrhage: diagnostic challenges and successful transcatheter embolization-a...

Post-colonoscopic splenic rupture with hemorrhage is a rare but fatal complication. Insidious onset and atypical symptoms hinder early diagnosis; we report one case to improve clinical vigilance.

A 67-year-old Han Chinese female underwent a screening colonoscopy under general anesthesia. The procedure was technically uneventful, and no polyps were resected or other therapeutic interventions were performed. Postoperatively, the patient developed progressive left upper quadrant pain radiating to the left shoulder. Physical examination revealed abdominal tenderness and guarding, and a decline in hemoglobin level suggested hemorrhage. Contrast-enhanced computed tomography (CT) confirmed splenic rupture with hemoperitoneum. Emergency splenic artery angiography and embolization were performed and successfully controlled the bleeding. The patient recovered uneventfully and was discharged on postoperative day 7.

Latrogenic splenic rupture is a rare complication associated with colonoscopy. In patients presenting with post-procedural pain in the left upper abdomen or pain radiating to the left shoulder, with or without hemodynamic changes, splenic injury should be strongly suspected. A favorable prognosis depends on rapid diagnosis and prompt management, in which endovascular interventions such as embolization play a critical role.