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 22 March 2018

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GastroenterologyColo-rectum and anus

Malignant diseases

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Ruptured spleen - complication of colonoscopy.

An 80-year-old woman was admitted with a two-day history of increasing abdominal pain. She also had left shoulder tip pain. The pain came on 12 hours after a colonoscopy. The colonoscopy had been uneventful, but the endoscopist had reported some difficulty in reaching the caecum. At the caecal pole he had identified a small neoplasm. A biopsy of this confirmed it was a moderately differentiated adenocarcinoma.

On examination the patient looked unwell and had widespread abdominal tenderness. A diagnosis of perforation following colonoscopy was made. No free gas was visible radiologically and it was assumed that the perforation had sealed and the gas reabsorbed. Her hemoglobin on admission was 93 g/L - and this was put down to the recently-diagnosed carcinoma of the caecum.

On review later that day, the patient was still unwell with marked generalized abdominal tenderness. A decision was made to proceed to laparotomy to resect the cancer and to deal with the perforation. The surgeon was surprised to find one litre of fresh blood in the peritoneal cavity - from a ruptured spleen. The spleen was surrounded by a massive subcapsular hematoma. The patient underwent a splenectomy and a right hemicolectomy.

The photographs shows the mobilized spleen and subcapsular hematoma in situ and removed. Also a photograph of the caecal neoplasm.

Comment: Rupture of the spleen after colonoscopy is extremely rare - fewer than 20 cases have been recorded in the literature.
Peter Devitt, Adelaide, Australia

Ruptured spleen - complication of colonoscopy.

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