Colonoscopy is the primary screening procedure for colorectal cancer and carries very low risk of complications (between 0.3 % and 0.35 %) [1]. It is estimated that 1.69 million colonoscopies are performed each year in the USA alone [2]. The most common complications are intraluminal gastrointestinal bleeding and colonic perforation [1]. Infrequently, hemoperitoneum occurs, mostly involving damage to the spleen. We present a case of hemoperitoneum following colonoscopy without splenic injury.
A 59-year-old female presented to our emergency department following a syncopal episode 12 hours after an unremarkable screening colonoscopy. Despite minor abdominal discomfort noted after the procedure, she resumed her normal activities. Pertinent history included a prior appendectomy. Besides pallor and minimal abdominal tenderness to palpation, physical exam was within normal limits. Laboratory tests showed a hemoglobin concentration of 10.4 g/dL and a hematocrit of 28.8 %. Leukocyte count, electrolytes, blood urea nitrogen, and creatinine were normal. Stool was guaiac negative. An abdominal radiograph excluded pneumoperitoneum ([Fig. 1]). Computed tomography (CT) scans of the abdomen and pelvis showed moderate amounts of free fluid demonstrating a density level suggestive of blood. The spleen appeared normal and there was no free air or extravasation of contrast from the bowel ([Fig. 2 a, b]). She was monitored for further bleeding and was subsequently discharged after 6 days.
Fig. 1 Abdominal radiograph centered at the diaphragm excludes the presence of pneumoperitoneum.
Fig. 2 Contrast-enhanced axial computed tomography images of (a) abdomen and (b) pelvis show intact spleen and free fluid with density measurements compatible with blood.
Intra-abdominal hemorrhage, a rare complication of colonoscopy, is most commonly reported in conjunction with splenic injury. Other documented causes of hemoperitoneum after colonoscopies include a torn mesenteric vessel, a ruptured epiploic appendix, and a necrosed intestinal leiomyosarcoma [3]
[4]
[5]. Due to the lack of other findings, it was speculated that the etiology in this case was a torn mesenteric vein. Intra-abdominal adhesions from her appendectomy could have contributed.
Endoscopy_UCTN_Code_CPL_1AJ_2AB
