Allegedly Negligent Colonoscopy Causes Spleen Injury

Case Overview

This case involves a 58- year-old-man who underwent an elective colonoscopy in an outpatient facility. He was discharged home shortly after the procedure. While at home, he began to feel very ill and fainted in his kitchen. He was brought to the emergency room where a spleen laceration was identified. Embolization was initially attempted, however, his hemoglobin continued to drop and he became increasingly symptomatic. He was then taken to the operating room for an emergent splenectomy, where an excess of blood was found in his chest cavity.

Questions to the Gastroenterology expert and their responses

How frequently do you perform colonoscopies?

I perform colonoscopies regularly.

What steps should be taken to avoid injury to the spleen during a colonoscopy?

The risk factors for splenic injury are both patient and operator dependent. Patient-dependent factors include pre-existing enlargement of the spleen, surgical adhesions, inflammatory bowel disease, and severe diverticular disease. Operator dependent factors include placing the patient on their back, excessive traction, over sedation, slide by advancement, and applying excessive external pressure. A review of the colonoscopy report is required to discern if the splenic injury was simply an unfortunate event or the result of technical errors.

About the expert

This expert has nearly 10 years of experience in the field of gastroenterology. He earned his BS in biology from the University of Michigan and his MD from Northwestern University School of Medicine. After completing a residency in internal medicine at Northwestern University, he went on to complete a fellowship in clinical nutrition at the University of Chicago and a second fellowship in gastroenterology at Rush University Medical Center. Today, this expert is board certified in gastroenterology and is active in his field as a member of the American Gastroenterology Association, the American Society of Nutrition, and the American Society of Gastrointestinal Endoscopy. Currently, he is the associate director of adult clinical nutrition, an associate professor of gastroenterology, and the co-director of the obesity program at a top university in Illinois.