Who should a patient follow up with after discharge following a splenic angiography and embolization for iatrogenic injury from colonoscopy?

Follow-up Care After Splenic Angiography and Embolization for Iatrogenic Injury

Patients who have undergone splenic angiography and embolization for iatrogenic injury from colonoscopy should follow up with their primary care provider, who should be made aware of the procedure. 1

Initial Post-Discharge Period

• Clinical and laboratory observation is the cornerstone of follow-up care in the first 48-72 hours after discharge for moderate and severe splenic lesions 1
• Patients should be counseled not to remain alone or in isolated places for the first few weeks after discharge and should be warned about alert symptoms that require immediate medical attention 1
• The risk of delayed splenic rupture is highest between 4-10 days after the initial injury, with mortality rates of 5-15% compared to 1% for acute rupture 2, 1

Imaging Follow-up

• CT follow-up after discharge should be considered for patients with:
  • Underlying splenic pathology 1
  • Coagulopathy 1
  • Neurological impairment 1
• Routine post-discharge follow-up CT is not necessary for low-grade (AAST grade I or II) injuries 1
• Doppler ultrasound (DUS) and contrast-enhanced ultrasound (CEUS) are useful alternatives for follow-up evaluation of splenic vascularization 1

Activity Restrictions

• Activity restriction is recommended for:
  • 4-6 weeks for minor injuries 1
  • 2-4 months for moderate and severe injuries 1
• Return to normal activity can be considered safe after at least 6 weeks for moderate and severe injuries 1

Vaccination Requirements

• Patients who have undergone splenic embolization should receive immunization against encapsulated bacteria (S. pneumoniae, H. influenzae, and N. meningitidis) 1
• Vaccination programs should ideally be started 14 days after the procedure 1
• If patients are discharged before 15 days post-procedure and there is a high risk of missing vaccination, they should be vaccinated before discharge 1
• Immunization against seasonal influenza is recommended for patients over 6 months of age 1

Infection Prevention

• Primary care providers should be informed about the patient's splenic angioembolization 1
• Antibiotic therapy should be strongly considered in the event of any sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, especially when medical review is not readily accessible 1
• Malaria prophylaxis is strongly recommended for travelers 1

Special Considerations

• Approximately 2% of patients discharged with a non-healed spleen may require late intervention 1
• Complete healing of splenic injuries is typically observed within 3 months, with healing times varying by injury grade 1
• Low-molecular-weight heparin (LMWH) prophylaxis may be safe in selected patients with splenic injury who have undergone non-operative management 1

Monitoring for Complications

• Patients should be monitored for potential complications such as:
  • Delayed splenic rupture 2
  • Post-traumatic splenic pseudoaneurysms 1
  • Splenic infarction or infection 3
• If pseudoaneurysms are found during follow-up, angioembolization should be considered 1