Behers Brett M, Behers Benjamin J, Thompson Anthony J, Hixson William C, Shah Rushabh S, Bernstein Marc L
University of South Florida College of Medicine, Tampa, FL, USA.
Florida State University College of Medicine, Tallahassee, FL, USA.
Transl Gastroenterol Hepatol. 2025 Apr 11;10:34. doi: 10.21037/tgh-24-93. eCollection 2025.
Splenic injury is a rare complication of upper endoscopic procedures described in case reports. These injuries can result in significant morbidity due to the spleen's vascularity and propensity for intraperitoneal bleeds. This review aims to collect data regarding patient characteristics, procedural factors, clinical presentations and treatment courses for analysis.
A systematic review of case reports on PubMed, Embase, and Web of Science was conducted for splenic injuries following upper endoscopic procedures (as of 14 July 2023). A total of 52 cases from 50 reports were included. All cases were from case reports or series, including conference abstracts, published in English. Cases were excluded if they were: not published in English; dealt with splenic injuries not following upper endoscopic procedures, including colonoscopy; documented a later complication of an upper endoscopic procedure, such as a migrating stent; not case reports or case series, such as review articles. Risk of bias was analyzed with Joanna Briggs Institute critical appraisal tools. Cases were analyzed using descriptive statistics.
The mean age was 56 years, with a median of 55 years, and a range of 21-86 years. Prior abdominal surgeries were identified in 31% of cases (16/52), and chronic pancreatitis in 15% (9/52). Procedural difficulty was reported in 21% (11/52). Most occurred following endoscopic retrograde cholangiopancreatography (ERCP) (71%, 37/52). Common symptoms were abdominal pain (79%, 41/52), hypotension and/or tachycardia (67%, 35/52), and postoperative drops in hemoglobin (58%, 30/52). Mean time to symptom onset was 21 hours, with a median of 4 hours, and a range of 0-144 hours. Most were diagnosed with computerized tomography (69%, 36/52), followed by laparotomy (17%, 9/52). Most were treated surgically (76%, 40/52). Most patients recovered fully (82%, 42/51).
Splenic injury is a rare complication of upper endoscopy that should be considered given the risk for delayed diagnosis and mortality. Most patients presented with abdominal pain and signs of hemorrhagic shock, although many had delayed onset of symptoms. Potential risk factors include prior abdominal surgeries, chronic pancreatitis, and difficult or prolonged procedures. Our review was limited by a low number of cases and inconsistent reporting of variables, which limited our statistical analysis.
脾损伤是上消化道内镜手术中一种罕见的并发症，已有病例报告描述。由于脾脏血管丰富且易发生腹腔内出血，这些损伤可导致严重的发病率。本综述旨在收集有关患者特征、手术因素、临床表现和治疗过程的数据进行分析。
对PubMed、Embase和Web of Science上关于上消化道内镜手术后脾损伤的病例报告进行系统综述（截至2023年7月14日）。共纳入50篇报告中的52例病例。所有病例均来自病例报告或系列研究，包括会议摘要，以英文发表。如果病例符合以下情况则被排除：非英文发表；处理的不是上消化道内镜手术后的脾损伤，包括结肠镜检查；记录的是上消化道内镜手术的后期并发症，如移位的支架；不是病例报告或病例系列，如综述文章。使用乔安娜·布里格斯研究所的批判性评价工具分析偏倚风险。使用描述性统计分析病例。
平均年龄为56岁，中位数为55岁，范围为21 - 86岁。31%（16/52）的病例有既往腹部手术史，15%（9/52）有慢性胰腺炎。21%（11/52）报告了手术难度。大多数发生在内镜逆行胰胆管造影术（ERCP）后（71%，37/52）。常见症状为腹痛（79%，41/52）、低血压和/或心动过速（67%，35/52）以及术后血红蛋白下降（58%，30/52）。症状出现的平均时间为21小时，中位数为4小时，范围为0 - 144小时。大多数通过计算机断层扫描诊断（69%，36/52），其次是剖腹手术（17%，9/52）。大多数接受手术治疗（76%，40/52）。大多数患者完全康复（82%，42/51）。
脾损伤是上消化道内镜检查中一种罕见的并发症，鉴于存在延迟诊断和死亡风险，应予以考虑。大多数患者表现为腹痛和失血性休克体征，尽管许多患者症状出现延迟。潜在危险因素包括既往腹部手术、慢性胰腺炎以及困难或耗时的手术。我们的综述受到病例数量少和变量报告不一致的限制，这限制了我们的统计分析。
