In the half-century since the first colonoscopy was performed in 1969, the procedure has become a mainstay for managing colorectal cancer screening and assessing bowel symptoms.1 In the United States alone, approximately 16 million colonoscopies are performed annually.2
Given that in the majority of cases the indication for the procedure is colon cancer screening or polyp surveillance, patients opt in to the procedure as a means of prevention. Colonoscopies are not without complications, including infection, bleeding, perforation, and, more rarely, splenic injury. Although all-cause colonoscopy complications only occur at a rate of 0.28%, morbidity and mortality from splenic injury in particular can be as high as 5% to 10%.3
Splenic injury as a complication of colonoscopy has been described largely in case reports and a small number of review articles. Most often occurring in seemingly unremarkable colonoscopies, splenic injury has manifested in a variety of clinical presentations. Consequently, ambiguity remains regarding which maneuvers and risk factors can lead to splenic injury.