Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2024; 30(7): 624-630
Published online Feb 21, 2024. doi: 10.3748/wjg.v30.i7.624
Trauma to the solid abdominal organs: The missed dark box of colonoscopy
Mohamed H Emara, Usama Mazid, Yasmine A Elshaer, Mahmoud A Elkerdawy, Dilaver Farooq Malik, Aya M Mahros
Mohamed H Emara, Yasmine A Elshaer, Mahmoud A Elkerdawy, Aya M Mahros, Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
Mohamed H Emara, Usama Mazid, Dilaver Farooq Malik, Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
Author contributions: Emara MH, Mazid U, Malik DF, and Mahros AM developed the concept; Emara MH, Elshaer YA, and Elkerdawy MA searched the literature; Emara MH, Mahros AM, and Malik DF analyzed the retrieved literature; Emara MH, Mazid U, Elshaer YA, and Elkerdawy MA prepared the tables and figure; Emara MH and Mazid U managed the case; Emara MH, Malik DF, and Mahros AM drafted the manuscript; all authors agreed and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed H Emara, MD, MSc, Professor, Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Algeish Street, Kafr-Elshikh 33516, Egypt. emara_20007@yahoo.com
Received: November 3, 2023
Peer-review started: November 3, 2023
First decision: December 14, 2023
Revised: December 21, 2023
Accepted: January 22, 2024
Article in press: January 22, 2024
Published online: February 21, 2024

Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure. Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used, the sedatives used, but to the procedure related as well including bleeding and perforation. Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon, however, serious complications related to the procedure have been reported infrequently in the literature. Life threatening injuries to the spleen, liver, pancreas, mesentery, and urinary bladder have been reported as early as in mid-1970s. These injuries should not be overlooked by clinicians and endoscopists. Steadily increasing abdominal pain, abdominal distension, and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury. Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening. Although conservative management may help, yet they usually need interventional radiology or surgical intervention. Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively. The mechanism of abdominal organ injuries during colonoscopy is not fully understood, however many risk factors have been identified, which can be classified as- organ related, procedure related, and local abdominal factors. Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries. Left lateral position, avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.

Keywords: Colonoscopy, Pancreatitis, Trauma, Complications, Adhesions

Core Tip: Although colonoscopy is seen as a potentially safe procedure performed as a daycare practice, yet it is associated with a wide range of complications. Emerging evidence in the literature documents injuries to abdominal organs beyond the bowel wall. The most commonly affected organ is the spleen, followed by the pancreas and infrequently the liver, mesentery and urinary bladder. Despite its low frequency, some cases are serious especially the rupture of visceral organs like spleen. In such cases, conservative management may not always work and interventional radiologic procedures and/or surgery may be required.