Splenic rupture following endoscopic mucosal resection: A case report and literature review

• Published in: Medicine (Baltimore) 2024-10, Vol.103 (40), p.e39846
• Main Authors: Ye, Yusong, Yang, Rui, Peng, Shicheng, Xiang, Qilang, Chen, Yuexi, Lü, Muhan, Yang, Weixing
• Format: Article
• Language: English
• Subjects: Abdominal Pain - etiology; Aged; Clinical Case Report; Endoscopic Mucosal Resection - adverse effects; Female; Humans; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Splenic Rupture - etiology; Splenic Rupture - surgery; Tomography, X-Ray Computed
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000039846

This study aims to highlight the rare but severe complication of splenic rupture following colorectal endoscopic mucosal resection (EMR), advocating for increased vigilance during procedures near the splenic flexure. We present a case report of a 66-year-old woman who experienced persistent abdominal pain after undergoing EMR for an adenomatous lesion in the distal transverse colon. The diagnosis of splenic rupture was established following her symptoms and clinical evaluation. Active conservative management was implemented after diagnosis. The patient's recovery underscores the importance of prompt diagnosis and careful monitoring. Although splenic rupture after EMR is extremely rare, it is a serious and potentially life-threatening complication. When obtaining informed consent, it is important to emphasize not only common complications like bleeding and perforation but also the risk of splenic injury. Physicians should select appropriate instruments and carefully adjust the angle and force of needle insertion, avoiding excessively long needles and vertical insertion. The procedure should be performed gently to minimize the risk of splenic rupture. For lesions near the splenic flexure, if postoperative abdominal pain occurs, regardless of left shoulder pain, splenic rupture should be considered, and a computed tomography scan promptly performed. Postoperatively, physicians should closely monitor vital signs and repeatedly check blood counts and coagulation parameters. Treatment should be tailored to the splenic injury's extent and the patient's overall condition, with immediate surgery if necessary. High-risk patients should be regularly followed up and instructed to monitor for physical changes. Endoscopists should remain vigilant during procedures, fully understanding potential complications, and closely monitoring the patient's condition postoperatively. This vigilance is key to preventing severe complications and ensuring optimal outcomes.