Splenic injury: a rare complication of endoscopic retrograde cholangiopancreatography.

Splenic injury is an extremely rare complication after endoscopic retrograde cholangiopancreatography (ERCP); to our knowledge, only seven such cases have previously been reported in the literature. Though the mechanism of splenic injury after ERCP is unclear, "bowing" of the endoscope in the "long position" with torsion on the greater curvature of the stomach may lead to splenic vascular or capsular avulsion. Other contributing factors potentially include excessive manipulation of the duodenoscope (particularly with difficulty cannulating the ampulla of Vater or common bile duct), excessive manipulation of the patient during the procedure, or the presence of intra-abdominal adhesions. As ERCP is being employed more frequently for the diagnosis and treatment of pancreatico-biliary disease, clinicians must be aware of this rare but potentially lethal complication to allow for early accurate diagnosis and therapy.