Santa Barbara Cottage Hospital, Santa Barbara, California, USA (Drs Loseth, Johnson, and Sharma)

ABSTRACT

Colonoscopy is a routine procedure to screen for colorectal cancer. Splenic injury is an extremely rare but potentially fatal complication. We present a case of a 74-year-old woman on edoxaban who underwent a screening colonoscopy at a nearby outpatient surgery center. While in the recovery room, she experienced abdominal pain, hypotension, and episodes of syncope, arriving to our Emergency Department approximately 10 hours after the colonoscopy. She presented to the Emergency Department with a distended abdomen, hypotensive, and with significant abdominal pain. Abdominal computed tomography scan showed significant hemoperitoneum around the bilateral paracolic gutters, spleen, and gastric fundus. She underwent emergent midline laparotomy with evacuation of 1.5 L of hemoperitoneum with ongoing bleeding from her deseroalized spleen, suggesting traction injury from colonoscopy. In patients with abdominal pain, hypotension, and low hemoglobin postcolonoscopy, splenic injury should be considered in order to recognize early and manage appropriately.

Key Words: Abdominal pain; Splenic injury; Colonoscopy; Spleen; Anticoagulant; Complication

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