BLUNT INJURY TO THE HEPATIC FLEXTURE SERIES

In 20,139 surgeon-performed colonoscopies, Smith and Nivatvongs 4 reported an overall complication rate of 0.4% for diagnostic colonoscopy and 1.8% for colonoscopy with polypectomy. In 1983, Macrae et al 5 reported no splenic injury in their review of 5,000 colonoscopies. 3 Smith and Nivatvongs 4 in 1975 reported no cases of splenic injury in a review of 7,959 cases. In 1987, only 6 cases of injury to the spleen after colonoscopy were reported. Nineteen spleen pathology notes were not detailed.ДЇrequency of Postcolonoscopic Complications In terms of spleen pathology, in 68 cases, 70.6% had grossly normal spleen pathology, and 1 was reported as amyloid.

The fifth death reported was an 81-year-old man who was managed with splenic artery embolization but developed exacerbation of chronic obstructive pulmonary disease and died of respiratory insufficiency 6В days after embolization.

BLUNT INJURY TO THE HEPATIC FLEXTURE SERIES

The second patient in this series died 16В days after colonoscopy because of postoperative respiratory failure from underlying pulmonary silicosis. The patient expired following the third operation. The first patient needed additional operations to control bleeding from the vascular pedicle, to relieve intestinal obstruction, and to repair intestinal perforation. In an 8-case series, Peterson et al 22 reported 2 patient deaths.

26 The second patient, an 82-year-old man, developed arrhythmia and shock following a blood transfusion. Of 5 (5.4%) reported deaths, the first reported was a 76-year-old man 3В weeks after colonoscopy and splenectomy after a prolonged hospital course with pneumonia, respiratory failure, and renal failure requiring dialysis. Postoperatively the patient recovered without complications. A total of 6 units of packed red blood cells was transfused. A splenectomy was performed without difficulty. There was active bleeding from the raw surface where the capsule had avulsed and from an associated deep laceration. The anterior capsule of the spleen was noted to be densely adherent to the splenic flexure of the colon and had avulsed. The blood was evacuated from the left upper quadrant and pelvis. An exploratory laparotomy revealed adhesions to the midline abdominal wall and a large amount of intraperitoneal blood. The computed tomography (CT) scan revealed grade IV splenic laceration with hemoperitoneum ( FigureвЂ…1). She was transfused with 2 units of packed red blood cells. Her hemoglobin was 6.4В g/L and hematocrit was 18.5% creatinine was 2.1В mg/dL. Her extremities were cool and clammy to touch. Her abdominal examination was consistent with tenderness in the left upper quadrant. She did not complain of left shoulder pain. In the emergency department, she was hypotensive with systolic blood pressure between 80 and 89В mmHg and tachycardic to 124 beats/minute. She developed abdominal pain 4В hours after her procedure. Her colonoscopy was uneventful and did not reveal a cause of her chronic anemia. Her history was significant for type 2 diabetes mellitus, rheumatoid arthritis, and hysterectomy. She had undergone colonoscopy the day prior for evaluation of chronic anemia. We present a case report followed by a review of the literature.ДЄ 47-year-old woman presented to the emergency department with abdominal pain. Splenic injuries after colonoscopy may be underreported and cases may remain undetected. 2 Splenic injury is a potential complication that can lead to significant morbidity. 2- в‡“ 4 Rare complications of colonoscopy include mesenteric tear, portal vein gas, pneumomediastinum, pneumothorax, retroperitoneal emphysema, retroperitoneal abscess, incarceration of hernia, septicemia, diverticulitis, appendicitis, and colonic volvulus. The most common complications associated with colonoscopy are perforation (0.1%-2.67%) and hemorrhage (0.001%-0.72%), as cited by multiple reviews of postcolonoscopy complications. Splenic injury as a result of colonoscopy is rare and was first reported by Wherry and Zehner 1 in a 1974 study that cited Hedberg's experience with 247 polypectomies. Colonoscopy is one of the most commonly performed procedures in the United States. Splenic injury is commonly associated with blunt and penetrating abdominal trauma.

Blunt injury to the hepatic flexture