Hemoperitoneum due to splenic injury after colonoscopy, a complication perhaps not so uncommon.

We present the case of a 72-year-old male smoker. His medical history showed a right lobectomy and adjuvant chemotherapy for lung adenocarcinoma. He was not under any kind of antiplatelet or anticoagulant medication. He had no history of abdominal surgery. An elective colonoscopy was performed with conscious sedation (midazolam and pethidine). The bowel preparation was appropriate. Diverticula and several pedunculated polyps were observed. After injection of diluted adrenaline (1/50000), a tubular adenoma with low-grade dysplasia measuring 20 millimeters in size was successfully removed using a diathermic loop at the splenic flexure. Post-resection mucosal defect was closed prophylactically with clip. 24 horas later, the patient was admitted to the emergency department due to abdominal pain and hypotension. There were no signs of peritoneal irritation. Laboratory analysis showed creatinine of 2.6 mg/dl, and C-reactive protein of 20 mg/L. Hemoglobin dropped from an initial level of 12.0 g/dL to 6.2 g/dL. A computerized tomography was performed (Fig. 1) after hemodynamic stabilization. The patient was treated with urgent splenectomy. He needed blood transfusion (six units of packed red blood cells). Postoperative course was uneventful and the patient was discharged home on day 5 after admission. Histopathological examination of his spleen revealed partial decapsulation. There was no evidence of underlying splenic disease. Discussion Our case presented tobacco consumption, oncol...
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research