Splenic injury is a rare but potentially life-threatening complication of colonoscopy, occurring in approximately 14-33 per 100,000 colonoscopies. This study aims to assess the incidence, risk factors, and clinical outcomes of splenic injuries requiring intervention following elective colonoscopy

A retrospective review was conducted at a tertiary centre, identifying all colonoscopies performed between 1 January 2014 and 20 March 2025. Patients who had a colonoscopy performed within 72 hours of a splenic injury requiring intervention were included. Cases with alternative causes for splenic injury were excluded. Patient demographics, risk factors, and outcomes were analysed.

Over the 10-year period, 6 cases of splenic injury requiring intervention were identified. All affected patients were female, with a mean age of 61.6 years (Standard Deviation = 16.3). 4 of 6 had previous abdominal surgery, and all procedures were performed under anaesthetist-led deep sedation.

Five injuries were identified within 6 hours post-procedure; one case presented at 48 hours. All patients reported abdominal pain, and 5 of 6 were haemodynamically unstable upon presentation. Angioembolisation was performed in 5 patients, achieving haemostasis in 4 (80%). Two patients required splenectomy—one following unsuccessful embolisation and one as a primary intervention. All patients required admission to the Intensive Care Unit with an average total length of stay in hospital of 9 days following colonoscopy

Female sex, history of abdominal surgery and anaesthetic led deep sedation were identified as potential risk factors for splenic injury post-colonoscopy. Implications for future practice include pre-procedural risk assessment including surgical history and potential for intra-abdominal adhesions, enhanced post-procedure monitoring of high-risk patients, and consideration to reviewing sedation practices to balance procedural comfort with patient safety