74-year-old female with past medical history of hypertension, diabetes, hyperlipidemia, and hypothyroidism, underwent a colonoscopy with polypectomy at AdventHealth Celebration on April 9, 2025. The procedure involved piecemeal endoscopic mucosal resection of an 18 mm ascending colon polyp. A minor complication was documented intra-procedure: a superficial submucosal tear, which was treated with hemostatic clips. The procedure note indicated minimal blood loss, no immediate complications, and the patient was discharged the same day.
Post-Procedure Clinical Course
The following morning, April 10, 2025, IP developed dizziness, generalized malaise, abdominal discomfort, and a syncopal episode at home. She presented to Cape Canaveral Hospital’s Emergency Department. Initial evaluation revealed hypotension and tachycardia. A CT scan of the abdomen and pelvis demonstrated moderate hemoperitoneum, with blood products surrounding the spleen and findings consistent with a splenic capsular laceration. Radiology specifically recommended surgical consultation.
Acute Management and Surgery
While in the emergency department, the patient’s hemodynamic status deteriorated, with systolic blood pressure dropping into the 70s and increasing tachycardia. She required transfusion of packed red blood cells and was started on vasopressor support. General surgery was urgently consulted, and IP was taken emergently to the operating room. She underwent exploratory laparotomy and splenectomy. Intraoperatively, splenic injury with hemorrhage was confirmed. She received multiple transfusions, was initially managed in the ICU, and was stabilized postoperatively.
Outcome and Discharge
IP remained hospitalized until April 14, 2025. Her final discharge diagnoses included splenic laceration status post splenectomy, hypovolemic/hemorrhagic shock (resolved), and acute blood loss anemia.
She was discharged home in stable condition with follow-up arranged with general surgery.
Looking to see if any deviations based on the attached procedure notes, seeing as it resulted in permanent loss of the spleen.
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Do you believe there might have been medical error?
The spleen sits in close proximity to the colon and can be injured during a colonoscopy. It is a less common but well described risk of colonoscopy and can occur due to scope moving around the splenic flexure and causing tension on the splenocolic ligament
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
As above, this is a known complication of colonoscopy, and one that is not typically apparent during the time of the colonoscopy or recovery
What makes you a good expert for this case?
I have reviewed other similar cases involving injury to the spleen due to colonoscopy
How often do you encounter cases similar to this one in your practice?
I have not seen them in my personal practice, but have been consulted by other attorneys to review other similar cases
Do you believe there might have been medical error?
Generally speaking, splenic laceration is an under recognized complication of even routine colonoscopy. It can be hard to diagnose and can present in a delayed fashion. The main aspect to review with respect to a medical error revolves around the patient assessment in the recovery room and management of any patient related concerns within the first typically 24 hours. The assessment would require going through the postoperative recovery notes, any communication between the patient and the Endoscopy staff in the first 24 hours, and any call logs between the patient and the office.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
see above, the medical team can do everything right and yet still this diagnosis can be missed given the opportunity for a delayed presentation, and inability to visualize any potential injury at the time of colonoscopy and in the absence of cross-sectional imaging. The assessment would require going through the postoperative recovery notes, any communication between the patient and the Endoscopy staff in the first 24 hours, and any call logs between the patient and the office.
What makes you a good expert for this case?
20 years of experience doing both routine and advanced endoscopy, my experience as Medical Director for a large ambulatory surgical center in Manhattan and my review of both inpatient and outpatient endoscopy related complications in my role as an associate professor of Medicine and associate chief of my division.
How often do you encounter cases similar to this one in your practice?
A few times per year, as mentioned, this is probably undiagnosed in many of our practices, but when it is missed the results can be quite catastropihc.
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