Splenicrupture: an unusual late complication ... - Europe PMC

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capsule due to pulling of the splenocolic ligament,2 rupture of pre-existing inflammatory adhesions between the colon and spleen3 or direct trauma to.
guided to the edge of the balloon (Fig. 2). After three attempts the balloon was punctured and the catheter easily removed. The patient was returned to his nursing home after a new catheter had been inserted, immediately after deflation.

Comments One of the potential complications associated with indwelling Foley catheters is an undeflatable balloon. Possible causes are absorption of water by latex catheters, blockage of the lumen by foreign bodies, and collapse of the lumen below the balloon. The usual methods of management include overdistension of the balloon' and insertion of a stylet into the lumen to rupture the balloon; however, the latter method is often difficult and ineffective.2

The advantages of real-time ultrasonography include easy visualization of.the catheter tip and localization of the inflated balloon within the bladder. The balloon can then be easily ruptured as described. Transvesical puncture with a spinal needle causes little trauma and is not associated with any complications.3 Although this method has previously been described,3 the problem is more easily solved than most clinicians appreciate. References 1. Pitt PC: Self-retained catheters. Br J Hosp Med 1974; 4: 174 2. Addonizio JC, Sayegh N, Sayegh N: Management of undeflatable Foley catheter balloon. Urology 1982; 19: 318 3. Moffat LE, Teo C, Dawson I: Ultrasound in management of undeflatable Foley catheter balloon. Urology 1985; 26: 79

Splenic rupture: an unusual

late complication of colonoscopy Mario Castelli, MD, FRCPC 10

erforation and hemorrhage of the colon are well known complications of colonoscopy. Reported rates of occurrence vary from 0.34% to 2.14% for perforation and from 1.8% to 2.5% for hemorrhage.1 Complications related to sedation and bowel preparation are also well recognized and include respiratory depression, injury from insertion of the enema tube, volume overload and abdominal pain. Although injury to visceral organs after colonoscopy has been reported,2-4 splenic rupture is not generally considered a complication of the procedure. Case report

A 71-year-old woman presented to the emerFrom the departments of Medicine and Gastroenterology, Henderson General Hospital and McMaster University, Hamilton, Ont.

gency department with acute abdominal pain and pain in the tip of her left shoulder. She had undergone colonoscopy the previous day because of a history of chronic intermittent abdominal pain and a recent history of passage of bright red'blood from the rectum. The endoscopist (a senior resident in gastroenterology who had performed approximately 50 colonoscopies) had used an Olympus CF-LB3R colonoscope (Olympus Optical Co., Tokyo). The patient had been given 20 mg of alphaprodine hydrochloride and 40 mg of hyoscine butylbromide, administered intravenously, immediately before' colonoscopy. The procedure had been performed with little difficulty, and the entire colon had been visualized; it had appeared normal apart from minimal diverticulosis. The patient had been discharged the same day in good condition, with no abdominal pain. She remained well until the following morning, when abdominal pain

developed. The patient's blood pressure was 130/80 mm Reprint requests to: Dr. Mario Castelli, McMaster Medicald Hg, pulse rate 100 beats/mmn and respiratory rate Unit, Henderson General Hospital, 711 Concession St., Ham-d 32/mmn. Her abdomen was distended, with diffuse ilton, Ont. L8V 1C3 11 tenderness. Bowel sounds were high pitched and

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reduced. Her hemoglobin level was 113 g/L and her leukocyte count 11.4 X 109/L. One hour later her systolic blood pressure was 65 mm Hg, and she was pale and diaphoretic. She was given intravenous fluids and blood transfusions. Three hours later her hemoglobin level was 53 g/L. Peritoneal lavage was performed to search for intra-abdominal bleeding, but only a small amount of blood was recovered; the bleeding was attributed to trauma from the procedure. A ruptured aortic aneurysm was tentatively diagnosed, and the patient was transferred to another hospital for surgery. Laparotomy showed the abdominal cavity to be filled with blood, and the inferior aspect of the splenic capsule was avulsed. Splenectomy was performed. The postoperative course was complicated by pneumonia, but the patient responded well to antibiotic treatment and was discharged home 14 days after splenectomy.

of mesenteries, ligaments and adhesions by the colonoscope is not well known. Injury to the spleen may result from avulsion of the splenic capsule due to pulling of the splenocolic ligament,2 rupture of pre-existing inflammatory adhesions between the colon and spleen3 or direct trauma to the spleen.4 Damage to the liver, in addition to the spleen, associated with pre-existing inflammatory adhesions due to Crohn's disease has also been reported.3 My patient did not have inflammatory disease, and there was no evidence of adhesions or of trauma to other visceral organs. Thus, the mechanism of injury appears to have been avulsion of the splenic capsule due to pulling of the splenocolic ligament. The delay in treatment could have been avoided if splenic rupture had been suspected earlier. References

Comments

Complications like perforation and hemorrhage of the colon during colonoscopy are well known and may be related to excessive inflation with air, direct puncture of the bowel wall or a diverticulum, or polypectomy. However, the potential for injury due to pulling and, possibly, tearing

1. Ghazi A, Grossman M: Complications of colonoscopy and polypectomy. Surg Clin North Am 1982; 62: 889-895 2. Telmos AJ, Mittal UK: Splenic rupture following colonos-

copy [C]. JAMA 1977; 237: 2718

3. Ellis WR, Harrison JM, Williams RS: Rupture of spleen at colonoscopy. Br Med J 1979; 1: 307-308 4. Smith LE: Complications of colonoscopy. Dis Colon Rectum 1975; 18: 214-220

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