Splenic injury is an uncommon but potentially fatal complication of colonoscopy with less than 100 reported cases in the literature.[1] The pathophysiologic foundation of this rare complication is not well-understood but is believed to be associated with stretching of the
splenocolic ligament secondary to the movement of colonoscope causing tear in the splenic capsule.[2] The most common presentation is abdominal pain that usually occurs during or immediately after the procedure although the pain can be delayed for up to 48-72 h after the injury.
Specific technical limitations linked to iatrogenic splenic injury include difficulty passing the colonoscope, looping of the instrument, traction on the
splenocolic ligament, adhesions between the colon and the spleen, and presence of a large polyp or mass at the splenic flexure [9].
The mechanism of injury is presumably due to downwards traction on the
splenocolic ligament or on adhesions around the spleen during colonoscopic manipulation causing a tear in the splenic capsule [2, 6, 8-10].
The congenital form results from a lack of development of the primary ligamentous attachments of the spleen: the gastrosplenic, splenorenal,
splenocolic splenophrenic, splenopancreatic, presplenic fold, pancreaticocolic, and phrenocolic ligaments (4).
The spleen is located in the left hypogastric quadrant of the abdomen and is fixed in its intraperitoneal position beneath the 9th to 11th intercostal spaces by the splenorenal,
splenocolic, splenogastric, and phrenicosplenic ligaments.
Present in approximately 10% of the population, accessory spleens arise from the fusion failure of the splenic anlage and reside in close proximity to the
splenocolic and gastrosplenic ligaments.
The lower pole of the spleen was mobilized next by dividing the
splenocolic ligament to bring down the splenic flexure of the colon followed by the dissection of the posterior attachments (splenophrenic and splenorenal ligaments) with the help of ultracision.
Dissection with an ultrasonic dissector (Ultracision LCS-5, Ethicon, Cincinnati, Ohio, USA) was commenced by mobilisation of the inferior pole of the spleen after division of the
splenocolic ligament.