Delayed Splenic Rupture 48 Hours After a Colonoscopy: A Case Report

Splenic rupture following colonoscopy, although uncommon, is a potentially life-threatening complication that all medical doctors should consider in their differential diagnosis. Several risk factors contribute to this condition, including exogenous elements such as the endoscopist's experience, patient positioning, medications, mechanical force during endoscope advancement, and technique at the splenic flexure, as well as endogenous factors like patient anatomy, perisplenic adhesions, inflammatory or infectious diseases, hematological disorders, malignancy, and interventions such as biopsy or polypectomy. We report a case of a 59-year-old woman who presented to the emergency department 48 hours after a colonoscopy with left upper quadrant abdominal pain, weakness, and pallor. Laboratory tests showed anemia. She had ongoing pain and hemodynamic instability, and a computed tomography revealed hemoperitoneum caused by splenic rupture. The patient underwent splenectomy and subsequently recovered without complications. Although colonoscopy remains the gold standard for diagnosing and managing colorectal diseases with a low incidence of serious adverse events, physicians should maintain a high index of suspicion for splenic injury in patients presenting with anemia and recent large bowel endoscopy.