title: Splenic injury during colonoscopy--a complication that warrants urgent attention.
abstract: BACKGROUND
  Colonoscopy is a safe procedure that is performed routinely worldwide. There is, however, a small but significant risk of splenic injury that is often under-recognized. Due to a lack of awareness about this injury, the diagnosis may be delayed, which can lead to an increased risk of morbidity as well as mortality. This paper presents a comprehensive review of the medical literature on colonoscopy-associated splenic injury and describes the clinical presentation and management of this rare but potentially life-threatening complication.
  
  
  METHODS
  A comprehensive literature search identified 102 patients worldwide, including patients from our experience, with splenic injury during colonoscopy. A meta-regression analysis was completed using a mixed generalized linear model for repeated measures to identify risk factors for this rare complication.
  
  
  RESULTS
  A total of 75 articles were identified and 102 patients were studied. The majority of the papers were in English (92 %). Only 23.4 % of patients (26/102) were reported prior to the year 2000. Among the patients reported after the year 2000, the majority (84.2 %, 64/76) were reported after 2005. There were more females (76.5 %), median age was 65 years (range, 29-90 years), and most of the colonoscopies were performed without difficulty (66.6 %). Nearly 67 % of patients presented within 24 h of colonoscopy with complaints ranging from abdominal pain to dizziness. The most common symptom was left upper quadrant pain (58 %), and CT scan was found to be the most sensitive tool for diagnosis. Seventy-three patients underwent operative intervention; 96 % of these were treated with splenectomy. Hemoglobin drop of more than 3 gm/dL was identified as the only significant predictor of operative intervention. The overall mortality rate was 5 %.
  
  
  CONCLUSIONS
  Splenic injury during colonoscopy is rare; however, it is associated with significant morbidity and mortality. Splenic injury warrants a high degree of clinical suspicion critical to prompt diagnosis, and early surgical consultation is warranted.
authors.affiliation: Department of Surgery, Temple University Hospital, Philadelphia, PA, USA. Smit.Singla@tuhs.temple.edu
authors.forename: S
authors.initials: S
authors.lastname: Singla
authors.forename: D
authors.initials: D
authors.lastname: Keller
authors.forename: P
authors.initials: P
authors.lastname: Thirunavukarasu
authors.forename: D
authors.initials: D
authors.lastname: Tamandl
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.forename: J
authors.initials: J
authors.lastname: Gaughan
authors.forename: D
authors.initials: D
authors.lastname: Dempsey
mesh_terms: D003113:Colonoscopy / Q000009:adverse effects*; D014943:Global Health; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy; D013161:Splenic Rupture / Q000453:epidemiology / Q000209:etiology / Q000601:surgery