title: Iatrogenic splenic injury: review of the literature and medico-legal issues.
abstract: Iatrogenic splenic injury is a recognized complication in abdominal surgery. The aim of this paper is to understand the medico-legal issues of iatrogenic splenic injuries. We performed a literature review on PubMed and Scopus using iatrogenic splenic or spleen injury and iatrogenic splenic rupture as keywords. Iatrogenic splenic injury cases were identified. Most cases were related to colonoscopy, but we also identified cases related to upper gastrointestinal procedures, colonic surgery, ERCP, left nephrectomy and/or adrenalectomy, percutaneous nephrolithotomy, vascular operations involving the abdominal aorta, gynecological operation, left lung biopsy, chest drain, very rarely spinal surgery and even cardiopulmonary resuscitation. There are several surgical procedures that can lead to a splenic injury. However, from a medico-legal point of view, it is important to assess whether the cause can be attributed to a technical error of the operator rather than being an unpredictable and unpreventable complication. It is important for the medico-legal expert to have great knowledge on iatrogenic splenic injuries because it is important to evaluate every step of the first procedure performed, how a splenic injury is produced, and whether the correct treatment for the splenic injury was administered in a judgment.
authors.affiliation: Department of Experimental Medicine, Second University of Naples, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Feola
authors.affiliation: Department of Advanced Biome-dical Sciences, University of Naples "Federico II", Naples, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Niola
authors.affiliation: Department of Surgery, Radiology and Public Health, Public Health and Humanities Section, University of Brescia - Centre of Bioethics Research, Italy.
authors.forename: Adelaide
authors.initials: A
authors.lastname: Conti
authors.affiliation: Department of Surgery, Radiology and Public Health, Public Health and Humanities Section, University of Brescia - Centre of Bioethics Research, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Delbon
authors.affiliation: Department of Advanced Biome-dical Sciences, University of Naples "Federico II", Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Graziano
authors.affiliation: University of Naples Federico II, Naples, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Paternoster
authors.affiliation: Department of Experimental Medicine, Second University of Naples, Naples, Italy.
authors.forename: Bruno Della
authors.initials: BD
authors.lastname: Pietra
keywords: Colonoscopy; Iatrogenic splenic injury; Professional liability; Spleen laceration; Spleen rupture; Splenectomy