Splenic Injury During Colonoscopy-a Complication that Warrants Urgent Attention
Splenic Injury During Colonoscopy-a Complication that Warrants Urgent Attention
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DOI：
10.1007/s11605-012-1871-0
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发表时间：
2012-06-01
影响因子：
3.2
通讯作者：
Dempsey, D.
中科院分区：
文献类型：
--
作者：
Singla, S.;Keller, D.;Dempsey, D.
结肠镜检查是一种安全的程序，在全球范围内都是常规进行的。然而，脾损伤有一个很小但很大的风险，往往被低估。由于对这种损伤缺乏认识，诊断可能会延迟，这可能会导致发病率和死亡率的增加。本文对结肠镜检查相关脾损伤的医学文献进行了全面的回顾，并描述了这种罕见但可能危及生命的并发症的临床表现和处理。全面的文献检索确定了全球102例患者，包括我们在结肠镜检查中发现的脾损伤患者。使用重复测量的混合广义线性模型进行Meta回归分析，以确定这一罕见并发症的危险因素。总共确定了75篇文章，研究了102名患者。论文以英文为主(92%)。只有23.4%的患者(26/102)是在2000年之前报告的。2000年以后报告的病例中，2005年以后报告的病例占84.2%(/76)。女性较多(76.5%)，年龄中位数为65岁(29~90岁)，大部分结肠镜检查无困难(66.6%)。近67%的患者在结肠镜检查后24小时内出现从腹痛到头晕的主诉。最常见的症状是左上腹疼痛(58%)，CT扫描是最敏感的诊断工具。73名患者接受了手术干预；其中96%的患者接受了脾切除术。血红蛋白下降超过3gm/dL被确认为唯一有意义的手术干预预测指标。总的死亡率为5%。结肠镜检查中的脾损伤很少见，但它与显著的发病率和死亡率有关。脾损伤需要高度的临床怀疑，这对迅速诊断至关重要，早期手术会诊是必要的。
Colonoscopy is a safe procedure that is performed routinely worldwide. There is, however, a small but significant risk of splenic injury that is often under-recognized. Due to a lack of awareness about this injury, the diagnosis may be delayed, which can lead to an increased risk of morbidity as well as mortality. This paper presents a comprehensive review of the medical literature on colonoscopy-associated splenic injury and describes the clinical presentation and management of this rare but potentially life-threatening complication.A comprehensive literature search identified 102 patients worldwide, including patients from our experience, with splenic injury during colonoscopy. A meta-regression analysis was completed using a mixed generalized linear model for repeated measures to identify risk factors for this rare complication.A total of 75 articles were identified and 102 patients were studied. The majority of the papers were in English (92 %). Only 23.4 % of patients (26/102) were reported prior to the year 2000. Among the patients reported after the year 2000, the majority (84.2 %, 64/76) were reported after 2005. There were more females (76.5 %), median age was 65 years (range, 29-90 years), and most of the colonoscopies were performed without difficulty (66.6 %). Nearly 67 % of patients presented within 24 h of colonoscopy with complaints ranging from abdominal pain to dizziness. The most common symptom was left upper quadrant pain (58 %), and CT scan was found to be the most sensitive tool for diagnosis. Seventy-three patients underwent operative intervention; 96 % of these were treated with splenectomy. Hemoglobin drop of more than 3 gm/dL was identified as the only significant predictor of operative intervention. The overall mortality rate was 5 %.Splenic injury during colonoscopy is rare; however, it is associated with significant morbidity and mortality. Splenic injury warrants a high degree of clinical suspicion critical to prompt diagnosis, and early surgical consultation is warranted.