Korean J Gastroenterol.  2020 Nov;76(5):246-250. 0000-0002-9018-9454.

Hemoperitoneum with Splenic Artery Rupture Following Diagnostic Colonoscopy

• Kang YW
• Lee JY
• Lee JH

• KMID: 2508874
• DOI: http://doi.org/0000-0002-9018-9454

Abstract

Colonoscopy is a safe and extremely popular diagnostic and therapeutic procedure. The most common complications are bleeding and perforation. Hemoperitoneum is a rare complication after a colonoscopy and is usually associated with splenic injury or solid organ pathology. This is potentially serious and can be life threatening. With the increasing number of colonoscopies performed, there has also been an increasing trend in reports of rare complications, such as pneumothorax, pneumomediastinum, appendicitis, small bowel perforation, septicemia, mesenteric tear, retroperitoneal abscess, and hemoperitoneum. This paper reports a unique case of hemoperitoneum after a recent colonoscopy without a splenic rupture or intra-abdominal abnormality, or external trauma. Most hemoperitoneum occurs within 48 hours after the inciting colonoscopy. In the present case, however, hemoperitoneum appeared 10 days after the colonoscopy. This case emphasizes that physicians should consider hemoperitoneum in a differential diagnosis of abdominal pain in patients after colonoscopy.

Keyword

Hemoperitoneum; Colonoscopy; Splenic artery; Angiography

Figure

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  Fig. 1 (A, B) Upon arrival at the emergency room, free air was not observed on the upright chest X-ray and the upright abdomen X-ray.

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  Fig. 2 (A, B) Abdominal computed tomography scan showed a massive hemoperitoneum along the perihepatic and perisplenic areas due to splenic artery rupture without splenic injury. Active bleeding was confirmed by extravasation of contrast agent throughout the splenic artery branches (white arrow).

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  Fig. 3 (A, B) Through superselective splenic angiography, splenic artery extravasation (white arrow) was identified.

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  Fig. 4 (A) Histoacryl glue was injected into the leaking splenic artery (white arrow). (B) Embolization using histoacryl glue was performed on the bleeding site (white arrow). (C) After embolization, using the contrast agent, it was confirmed that the splenic artery no longer leaked (white arrow).

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