Published online Feb 27, 2020. doi: 10.4240/wjgs.v12.i2.55
Peer-review started: September 6, 2019
First decision: September 28, 2019
Revised: November 23, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: February 27, 2020
Colonoscopy is a routine diagnostic and therapeutic procedure. Rarely, colonoscopy can cause splenic Injury.
Splenic injury is a rare but fatal complication of colonoscopy. We wanted to study the various research manuscripts published on splenic injuries during colonoscopy and find out the most common indications for colonoscopy, various presentations of patient with spleen injury, different types of injury, diagnosis and management of splenic injury.
The main objectives were to investigate the reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients
A structured search on four databases was done and 45 articles with 68 patients were selected. and analyzed using SPSS. A literature search for relevant articles was performed through April 25, 2019, using MEDLINE (PubMed, Ovid), Embase and Cochrane databases. We selected manuscripts which inlcuded subjects with any type of spleen injury secondary to colonoscopy and discussed the mechanism, diagnosis and outcome of spleen injury.
We found that the mean age of the patients was 62.7 years with females predominance. Some of the patient (20%) had a complete splenic rupture, while majority (63%) had subcapsular hematoma, spleen laceration and spleen avulsion. We noticed that the most common reason for colonoscopy was screening (46%) followed by diagnostic colonoscopy (28%). Most common presentation was with abdominal pain. Patients with spleen rupture mostly required splenectomy (47%), while minor spleen hematomas and lacerations were managed conservatively (38%). Few patients (6%) were managed with proximal splenic artery splenic embolization and 4% were managed with laparoscopic repair. The overall mortality was 10% while 77% had complete recovery. Majority of the patients with splenic rupture were managed with splenectomy while the rest were managed conservatively (P = 0.04). This association was moderately strong at a cramer’s V test (0.34). The Fisher exact test showed a higher mortality with spleen rupture (P = 0.028).
We found that the most common reason for colonoscopy among patients with splenic injuries was screening colonoscopy. The most common presentation was with abdominal pain. Computed tomography abdomen was diagnostic mode of choice. Majority of the patients with splenic rupture were managed with splenectomy and overall mortality was 10%. Recently, monitored anesthesia care has been used in majority of the patients for anesthesia during colonoscopy. Propofol has been used as a part of the protocol. It has been postulated that compared to conscious sedation, deep sedation is expected to blunt patient responses to painful stimuli which can lead to traumatic injuries during colonoscopy like splenic injury and perforation. Majority of the manuscripts did not have information on anesthesia protocol, which would have provided valuable information.
Further studies are needed to find the likely etiology of splenic injury during. Anesthesia with propofol has been postulated to be one of the reasons for splenic injury as it might blunt patient responses to painful stimuli.