Ruptura esplénica tras colonoscopia diagnóstica

Male of 67 years of age with a history of ischemic heart disease and bypass graft aorto-biliac currently being treated with clopidogrel, atenolol, isosorbide mononitrate, and statins, who underwent colonoscopy because of general syndrome and anemia. A colonoscopy was performed with sedation medication administered (midazolam 4 mg and fentanyl 0.05 mg) and without complications to report, showing only internal hemorrhoids. Two hours later and after ensuring full recovery, the patient was discharged. Eight hours after the discharge, the patient experienced abdominal pain and sixteen hours later the patient suffered a presyncope episode and was transferred to an emergency department. A blood analysis showed that the patient presented anemia (9.5 g/dL hemoglobin) and an abdominal CT scan (Fig. 1) displayed a subcapsular hematoma of the spleen that was over 10 cm with active bleeding and hemoperitoneum. As the patient presents hemodynamic instability an emergency laparotomy with splenectomy and ligation of vessels was performed. Presence of 2 liter hemoperitoneum without intestinal perforation was confirmed during surgery. After the operation the patient made a satisfactory recovery and was discharged seven days later.