Splenic Injury with Subsequent Pleural Effusion: An Underreported Complication of Colonoscopy.

Colorectal cancer is a leading cause of morbidity and mortality worldwide. As such, there are recognized guidelines in the screening of this preventable cancer. There are differences in opinion regarding screening recommendations between the European and United States Cancer Prevention Societies. Screening colonoscopy is an option for routine screening for colorectal cancer in asymptomatic adults. It is a day procedure that is conducted both in hospital and specialized outpatient endoscopy suites. Serious harm is in the region of 3 per 1,000 examinations [Am J Gastroenterol. 2016 Aug; 111(8): 1092-101]. Splenic injury is a rare complication of colonoscopy whose frequency is unclear. Conservative management of splenic injury is desirable in order to preserve immunocompetence. We present a case in which a previously healthy 59-year-old female developed a splenic injury and later pleural effusion after screening colonoscopy.

A Pathognomonic Electrocardiogram That Requires Urgent Percutaneous Intervention: A Case of Wellens Syndrome in a Previously Healthy 55-Year-Old Male.

BACKGROUND Acute chest pain is a common presentation in emergency departments worldwide. Ruling out acute coronary syndrome is essential in ensuring patient safety. Workup includes electrocardiogram (ECG) and cardiac biomarkers. Wellens syndrome is characterized by a history of chest pain, normal or minimally elevated biomarkers, no STEMI/Q-waves, and specific ECG changes. These changes consist of biphasic T waves in lead V2 and V3 or deep symmetrically inverted T waves in leads V1-V4. CASE REPORT A 55-year-old male presented to the emergency department with acute chest pain in a background of active smoking, hypertension, and hyperlipidemia. His ECG was characteristic of Wellens syndrome type 1 and negative cardiac biomarkers. His TIMI (thrombolysis in myocardial infarction) score was 2, however, he failed conservative management necessitating urgent coronary angiogram. Critical stenosis of the proximal left anterior descending (LAD) coronary artery was found which required 2 drug eluting stents. He was discharged home asymptomatic on optimal medical therapy. CONCLUSIONS Conventional management of patients with NSTEMI (non-ST-elevation myocardial infarction) and unstable angina with risk stratification utilizing TIMI score may not be appropriate in patient with Wellens syndrome. This highlights the importance of ECG recognition and urgent percutaneous intervention in patients with Wellens syndrome. Failure to identify this clinical syndrome could result in significant morbidity and mortality because it relates to critical stenosis and imminent large myocardial infarction.

Splenic rupture after screening colonoscopy: case report and literature review.

Splenic rupture is a rare complication after colonoscopy, and to date there are only 46 reported cases in the English-language literature. Presented is a case report of splenic rupture after screening colonoscopy that resulted in laparotomy and splenectomy within 24 hours of the original procedure. The article covers the hypothesized mechanisms of injury, various precautions to take during colonoscopy, suggested diagnostic algorithm, determining factors in treatment, and vaccine regimen. The article concludes by stating that as the number of colonoscopies increase, so will the prevalence of associated complications, and that physicians are encouraged to understand this paradigm shift.