title: A systematic review of splenic injuries during colonoscopies: Evolving trends in presentation and management.
abstract: BACKGROUND
  Although uncommon, the incidence of splenic injury from colonoscopy has been increasing significantly since first being reported in 1974. Early recognition is critical because mortality may be as high as 5%.
  
  
  METHODS
  We systematically searched PubMed and EMBASE to identify English-language cases of splenic injury from colonoscopy from inception until January 26, 2015. We used descriptive statistics to characterize the identified cases.
  
  
  RESULTS
  A total of 172 cases from 122 reports were included. The mean age was 64 years and 70.8% were females. Prior abdominal or pelvic surgeries were identified in 63.8%. 57.3% of patients underwent polypectomies or biopsies. There was a statistically significant increase in use of computerized tomography for diagnosis in the past 5 years (81.8% versus 65.2%). 76.1% patients received transfusions. Mean inpatient length of stay was 7.83 ± 5.32 days. A non-significant trend toward conservative management was noted in the past 5 years (37.7% versus 23.1%), and a non-significant drop in mortality was noted (4.9% versus 5.4%).
  
  
  CONCLUSIONS
  Our data support prior literature suggesting a higher incidence of splenic injuries during colonoscopies in females, advanced age, prior history of abdominal/pelvic surgeries and biopsies/polypectomies during the procedure.
  
  
  CONCLUSIONS
  Significant mortality associated with splenic injuries during colonoscopies warrants prompt recognition of this potentially life threatening, albeit uncommon, complication.
authors.affiliation: Department of Internal Medicine, Reading Health System, Spruce St/6th Ave, West Reading, PA 19611, United States. Electronic address: asadjehangir@gmail.com.
authors.forename: Asad
authors.initials: A
authors.lastname: Jehangir
authors.affiliation: Department of Internal Medicine, Reading Health System, Spruce St/6th Ave, West Reading, PA 19611, United States. Electronic address: Dilli.Poudel@readinghealth.org.
authors.forename: Dilli Ram
authors.initials: DR
authors.lastname: Poudel
authors.affiliation: Department of Gastroenterology, Digestive Disease Associates, 1011 Reed Ave #300, Wyomissing, PA 19610, United States. Electronic address: anirudhmrai@yahoo.com.
authors.forename: Anirudh
authors.initials: A
authors.lastname: Masand-Rai
authors.affiliation: Department of Internal Medicine, Reading Health System, Spruce St/6th Ave, West Reading, PA 19611, United States. Electronic address: Anthony.Donato@readinghealth.org.
authors.forename: Anthony
authors.initials: A
authors.lastname: Donato
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D003113:Colonoscopy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D013161:Splenic Rupture / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D014057:Tomography, X-Ray Computed
keywords: Colonoscopy; Computerized tomography; Injury; Mortality; Splenic