Splenic Laceration Complication during a Screening Colonoscopy

A Screening colonoscopy is a seemingly routine procedure for most gastroenterologists. With appropriate preparation and visualization one can minimize risks such as perforations, bleeding from biopsies and snare polypectomies or even from adverse reactions to sedatives that are used throughout the procedure. What is less common however, are splenic lacerations that occur secondarily to colonoscopy. We present a case of such complication in a female who presents with chronic abdominal pain for a year after colonoscopy. Our patient is a 64 year old female with a pertinent past medical history of HTN, last colonoscopy one year ago and last EGD 7 years prior. She presents with chronic generalized abdominal pain with occasional localization to the RLQ for the past year. Her presentation is remitting and relapsing in nature without full resolution. She denied any recent NSAID use, recent trauma or any concerns for GI bleeding. Surgery was consulted for concerns of cholelithiasis on ultrasound and possible laparoscopic appendectomy. Findings did not completely explain her initial presentation however thus EGD and Colonoscopy were subsequently planned. EGD illustrated chronic gastritis and colonoscopy was without any significant findings. Patient had a positive HIDA scan and subsequently underwent laparoscopic cholecystectomy. During the procedure however, blood was noted in the peritoneum prior to removal. After removal of the gallbladder, she underwent a CT of the abdomen and pelvis that revealed a Grade 1 splenic laceration without any active extravasation. She was discharged from the hospital with appropriate outpatient follow up within 1-3 weeks.