Reducing the Risks of Spleen Injury After Colonoscopy

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Spleen injury from colonoscopy accounts for 4% of medical malpractice claims among gastroenterologists insured by MagMutual. While these injuries are uncommon, mortality from this complication remains significant, therefore representing an important area of risk for physicians performing colonoscopy procedures. 

To help gastroenterologists reduce the occurrence of spleen injuries from colonoscopy procedures, MagMutual’s medical faculty and risk consultants have analyzed our claims data, determined the main causes of claims related to this injury and developed strategies to improve patient outcomes.

Top Risks

Top Strategies for Reduction

Based on these top risk drivers, implementing the following clinical and operational strategies can help you prevent unexpected outcomes and increase defensibility of a medical malpractice claim:

Clinical strategies

• Consider water immersion insertion technique (which is less likely to result in looping compared to an air insertion technique).
• If possible, perform the colonoscopy by placing the patient in the left lateral position to decrease splenic-colonic tension.
• Incorporate holding of blood thinners in pre-op checklist performed by endoscopy nursing staff. In general, holding anticoagulants should be done in coordination with the anticoagulant prescriber. 

Operational strategies

• Provide discharge paperwork with clear instructions for patients who may experience any concerning symptoms after the procedure.
• Consider developing clear protocols for response by the practice team based on potential post-procedure symptoms.

Other Top Risks

Although spleen injury from colonoscopy accounts for a significant number of claims among gastroenterologists according to our data, we’ve identified several other drivers of loss based on claims frequency:

Risk Drivers by Top Cause

Risk Drivers by Frequency

Data Collection & Methodology

Data is based on MagMutual closed claims from 2011-2021 and corresponding exposure data. Clinical and non-clinical loss drivers are based on an in-depth review of each claim by a medical professional or clinical risk consultant. Risk reduction strategies are based on input from practicing physicians.