Zarak H. Khan, MD, Pranay R. Korpole, MD, Vijay Jarodiya, MD, Tejveer Singh, MD, Nabil Sultani, MD
St. Mary Mercy Hospital, Livonia, MI
Introduction: Colonoscopy is considered to be a low risk procedure performed regularly worldwide. The most common complications include hemorrhage and bowel perforation which are 1% and 0.1% respectively. The incidence of spleen rupture is estimated to be between 0.00005 and 0.017 % . However, due to its nonspecific presentation many cases may be misdiagnosed and up to 11% of these patients will be discharged with a different diagnosis. Therefore, the actual incident is likely higher. We present a case of a 76-year-old female with spleen rupture 16 days after a routine colonoscopy.
Case Description/Methods: 76-year-old female with past medical history of atrial fibrillation on apixaban, coronary artery disease, recurrent bladder cancer and chronic obstructive pulmonary disease presented for sudden onset of chest pain. Pain was 10/10 in intensity and located in the left anterior chest wall with radiation to the left shoulder. She also had associated nausea without vomiting. Patient denied any history of trauma. Patient underwent an uncomplicated colonoscopy 16 days earlier during which a 1.3 cm polyp was excised. Upon presentation, vital signs were significant for a blood pressure of 96/58. Labs were significant for hemoglobin of 7.2 and INR of 1.6. CT scan of the abdomen showed findings suspicious for splenic rupture. Patient received 2 units of packed RBCs in the ED and was then taken to the OR for emergent exploratory laparotomy. Intra-operatively, the spleen was found to be ruptured and splenectomy was performed. She did not have any complications during or after the splenectomy and was discharged 6 days after the procedure in stable condition. Appropriate vaccinations were administered upon discharge.
Discussion: There are many proposed mechanisms for spleen injury during colonoscopy; these include tension on the splenocolic ligament, tension on pre-existing intra-abdominal adhesions and direct injury to the spleen during passage of the colonoscope through the splenic flexture. We speculate that our patient's use of apixaban might have played a contributing role. To our knowledge, only 5 cases of splenic injury have been previously reported with time of presentation greater than 16 days post-colonoscopy. Our patient's symptoms and location of pain are not typical for splenic injury. With our case, we intend to spread awareness about this not so uncommon and possibly fatal complication of colonoscopy with delayed and sometimes atypical symptoms.
Citation: Zarak H. Khan, MD, Pranay R. Korpole, MD, Vijay Jarodiya, MD, Tejveer Singh, MD, Nabil Sultani, MD. P0154 - LEFT-SIDED CHEST PAIN FOLLOWING COLONOSCOPY: THINK OUTSIDE THE COLON!. Program No. P0154. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.