title: Splenic rupture following colonoscopy: Case report and literature review.
abstract: BACKGROUND
  Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for colorectal diseases. Although bleeding and perforation are most common complications, extra colonic or visceral injuries have been described. Splenic rupture is rare with few cases reported in current literature.
  
  
  METHODS
  We report the case of a 73-year old man who presented to surgical consultation 50h after colonoscopy. Clinical, laboratory and imaging findings were suggestive for haemoperitoneum. At surgery an almost complete splenic disruption was evident and urgent splenectomy was performed.
  
  
  CONCLUSIONS
  Splenic injury following colonoscopy is exceptional, probably related to instrumental looping with excessive traction on the splenocolic ligament. In patients with an early presentation a sudden onset of symptoms is the rule. By contrast a delayed presentation (>48h) is nonspecific and subtle with arduous diagnosis.
  
  
  CONCLUSIONS
  Awareness of this potential complication, high level of suspicion and prompt treatment are at the basis of better outcomes in such patients.
authors.affiliation: University of Milan, Department of general and emergency surgery, Ospedale S. Famiglia Fatebenefratelli-Erba, Italy. Electronic address: marcoantonio.zappa@libero.it.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Zappa
authors.affiliation: University of Milan, Department of general and emergency surgery, Ospedale S. Famiglia Fatebenefratelli-Erba, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Aiolfi
authors.affiliation: University of Milan, Department of general and emergency surgery, Ospedale S. Famiglia Fatebenefratelli-Erba, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Antonini
authors.affiliation: University of Milan, Department of general and emergency surgery, Ospedale S. Famiglia Fatebenefratelli-Erba, Italy.
authors.forename: Cinzia Domenica
authors.initials: CD
authors.lastname: Musolino
authors.affiliation: University of Milan, Department of general and emergency surgery, Ospedale S. Famiglia Fatebenefratelli-Erba, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Porta
keywords: Colonoscopy; Haemoperitoneum; Splenectomy,; Splenic injury grading; Splenic rupture