Splenic rupture as a rare colonoscopy complication: a case report with clinical and medico-legal insights

Background: Splenic rupture is an exceedingly rare but potentially life-threatening complication of colonoscopy, with an estimated incidence of less than 1 in 100,000 procedures and a reported mortality rate of up to 5%. Due to its non-specific and often subtle clinical presentation—typically involving left upper quadrant or generalized abdominal pain—it may be misdiagnosed or diagnosed late, which can result in a significant worsening of patient outcomes. Early recognition and prompt management are therefore essential not only for improving clinical prognosis but also for preventing potential medico-legal disputes related to diagnostic delays or alleged procedural negligence. Raising awareness among clinicians of this rare complication, especially in the presence of risk factors such as difficult colonoscopy, adhesions, or splenomegaly, is of critical importance. Case Description: A 68-year-old woman underwent a routine colonoscopy for recurrent polyps. The procedure was uneventful, and she was discharged with post-procedural instructions. The following day, she developed persistent abdominal pain, initially treated with analgesics. Progression to hypotension and abdominal distension prompted emergency imaging, revealing hemoperitoneum due to splenic rupture. An emergent splenectomy was performed, confirming multiple splenic lacerations. The patient recovered fully postoperatively with supportive management. Conclusions: This case highlights the importance of maintaining a high index of suspicion for splenic injury in patients presenting with delayed abdominal pain after colonoscopy. Detailed informed consent, strict post-procedural monitoring, and patient education are essential for minimizing complications and addressing medico-legal challenges.