![]() ![]() The failure rate of conservative management has been reported up to 44%. #SPLENIC FLEXTURE XRAY SERIAL#Conservative management with observation, serial abdominal exams, and frequent hemoglobin checks is suggested for hemodynamically stable patients. Management depends on the type of injury and hemodynamic status of the patient. Contrast-enhanced CT abdomen is the diagnostic modality of choice in suspected cases with a sensitivity of 98.5%. ![]() Hemodynamic instability can also be seen in the case of significant intraperitoneal bleeding. Left-upper quadrant or generalized abdominal pain is the most common presenting complaint followed by left shoulder pain. Patients usually develop symptoms within 24 hours after the procedure. Difficult colonoscopy, splenomegaly, biopsies, and polypectomy are also among the known risk factors. Excessive traction on the splenocolic ligament and splenocolic adhesions from previous abdominal surgery, certain maneuvers including hooking the splenic flexure to straighten the left colon, and direct trauma to the spleen while passing the scope through the splenic flexure have all been hypothesized as potential causes. The exact mechanism of splenic injury during colonoscopy remains unknown. It is seen more commonly in females with a mean age of 63 years. Incidence is reported to be around 1/100,000 procedures. Splenic injury is a rare but serious complication of colonoscopy with a mortality rate of 5%. Hemorrhage (1% to 2%) and colonic perforation are common complications with an incidence of 1% to 2% and 0.1 to 2% respectively. Colonoscopy is considered a safe procedure. ![]()
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