Splenic rupture following colonoscopy, a rare complication.

Splenic rupture is an extremely rare complication of colonoscopy. So far, less than 80 cases have been reported worldwide since 1970. We report two patients, one patient presenting with haemorrhagic shock after a therapeutic colonoscopy and another patient presenting with abdominal pain following a diagnostic colonoscopy. In both cases splenic rupture was diagnosed by abdominal computed tomography (CT scan). One patient was treated by selective embolisation of the splenic artery; the other patient underwent a splenectomy. Because the numbers of colonoscopies performed in The Netherlands as well as in many other European countries are likely to double in the coming years as a result of the introduction of nationwide colorectal cancer screening programmes and intensive surveillance protocols after polypectomy, more splenic injuries as a complication of colonoscopy can be expected in the near future. Awareness of this complication is of great importance in early recognition and management of this potentially life-threatening injury.

Right heart failure: diagnosis via ultrasonography of the inferior vena cava and hepatic veins.

PURPOSE: To determine the efficiency of ultrasonographic measurements of the inferior vena cava (IVC) and hepatic vein (HV) in the detection of elevated systemic venous pressure due to right heart failure. MATERIAL AND METHODS: Measurements of the Collapsibility Index (CI) of the Inferior vena cava (IVC) and hepatic vein (HV) was obtained from 95 persons without right failure. The CI values of 32 patients with clinically documented right heart failure and the data of a subgroup of 24 patients who received therapy, were statistically compared to those of the group without right heart failure. RESULTS: There were statistical significant differences between the CI of the persons without and the patients with right heart failure and between the patients before and after therapy (two-sample T-test: p < 0.05). The position of the ROC curve indicates that measurements of the CI of the IVC and HV enables to distinguish very well patients with right heart failure from those without right heart failure. If the cut-off CI value between normal and abnormal of the IVC was set at 0.22, the sensitivity was 78% and the specificity 98%. When the cut-off value of the CI of the HV was set at 0.25 the sensitivity was 78% and the specificity 96%. There was good interobserver agreement with regard to the CI values of the IVC (correlation coefficient 0.65), but poor interobserver agreement with regard to the CI values of the HV (correlation coefficient 0.35). CONCLUSION: Ultrasonographic measurement of the CI of the inferior vena cava is particularly useful to exclude systemic venous congestion in right heart failure and to monitor the effect of therapy.

Acute whiplash injury: is there a role for MR imaging?--a prospective study of 100 patients.

PURPOSE: To evaluate the findings from magnetic resonance (MR) imaging of the cervical spine and brain after acute whiplash injury. MATERIALS AND METHODS: Within 3 weeks of trauma, 100 patients underwent MR imaging for evaluation of the cervical spine and the brain. In addition, plain radiographs were obtained, including functional images of the cervical spine. RESULTS: Only one patient had an abnormality on the MR image that was related to trauma (ie, prevertebral edema). In 17 patients, functional images showed a kyphotic angle, but no evidence of soft-tissue injury was seen on MR images. CONCLUSION: There is no role for MR imaging in the routine work-up of patients with acute whiplash injury who have normal plain radiographic findings and no evidence of a neurologic deficit. A kyphotic angle seen on functional images of the cervical spine should not be assumed to indicate soft-tissue injury and is most likely attributable to a compensating mechanism of hypermobility at a level of the spine above that at which hypomobility occurs, which is probably the result of a muscle spasm.