Rare case of delayed splenic injury post colonoscopy in a regional hospital

Colonoscopy complications

Abstract

Splenic injury is a rare but recognized complication of colonoscopy. Although most injuries present within 24–48 hours, delayed presentations up to 7–13 days have been reported, likely related to traction on splenic ligamentous attachments during maneuvers at the splenic flexure. A 52-year-old woman underwent an uncomplicated elective colonoscopy with cold-snare polypectomy and remained asymptomatic until day 6, when she developed pleuritic left-sided chest pain, tachycardia, and mild left upper quadrant discomfort. Pulmonary embolism was initially suspected; CT pulmonary angiography showed no embolus but incidentally demonstrated a perisplenic subcapsular hematoma. CT mesenteric angiography confirmed a stable hematoma without arterial extravasation, with a small volume of reactive intraperitoneal fluid. She was managed conservatively with serial abdominal examinations, 6-hourly hemoglobin monitoring, intravenous fluids, and patient-controlled analgesia. Her hemoglobin decreased from 128 g/L to 93 g/L over 24 hours and then remained stable without transfusion; repeat imaging showed mild interval progression of hemoperitoneum without active bleeding. One month later, she re-presented with tachycardia and abdominal discomfort; imaging demonstrated a resolving hematoma with a reactive left pleural effusion. This case highlights delayed splenic subcapsular hematoma following an otherwise uncomplicated colonoscopy and emphasizes the need to consider splenic injury in patients presenting with left upper quadrant pain or pleuritic chest pain after recent colonoscopy, where early imaging and careful monitoring can support safe non-operative management in hemodynamically stable patients.