title: Diagnosis and management of splenic injury following colonoscopy: algorithm and case series.
abstract: BACKGROUND
  Splenic injury following colonoscopy is a rare yet life-threatening complication. These injuries are often associated with delayed diagnosis and may require invasive intervention. We sought to study the emergent presentation associated with splenic injury post-colonoscopy and to suggest a new treatment algorithm.
  
  
  METHODS
  Six cases of splenic injury following colonoscopy were collected from three medical centers. Data regarding patient medical history, clinical presentation, laboratory and imaging findings and clinical management were recorded. A systematic PubMed/MEDLINE search was performed. Non-English-language publications and publications dating earlier than 2010 were excluded. An emergency department trauma-based management algorithm was designed according to the identified publications and review of the available trauma literature.
  
  
  RESULTS
  The mean age was 65.3 years and the male-to-female ratio was 1:5. Five of the cases presented within 24 h of the colonoscopy complaining of severe abdominal pain. Hemodynamic instability was noted in four patients who presented with tachycardia (105-130), hypotension and/or a rapid drop in hemoglobin levels. All of the patients underwent initial resuscitation and a computerized abdominal tomography scan. Four of them required emergent splenectomy. No mortality or major morbidity was reported following the hospitalization.
  
  
  CONCLUSIONS
  Although very rare, splenic injury during colonoscopy is an acute, severe and possible fatal complication. Patients may present with a rapid clinical deterioration and hemodynamic instability. Physicians should be familiar with the practical management of this surgical emergency and the treatment options available.
authors.affiliation: Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Lahat
authors.affiliation: Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel. Dr.Nevy@Gmail.com.|The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012, Chaim Sheba Medical Center, Tel-Hashomer, Israel. Dr.Nevy@Gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Nevler
authors.affiliation: Department of Surgery, Barzilai Medical Center, Ashkelon, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Batumsky
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Shapiro
authors.affiliation: Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Zmora
authors.affiliation: Department of Surgery B, Chaim Sheba Medical Center, 52621, Tel-Hashomer, Ramat-Gan, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Gutman
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D000368:Aged; D000465:Algorithms; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D013156:Splenectomy; D014057:Tomography, X-Ray Computed
keywords: Colonoscopy; Iatrogenic injury; Intraabdominal bleeding; Splenic injury