Table 2.

Proposed Risk Factors for Splenic Injury During Colonoscopy^1–42

Endoscopist Dependent

Excessive traction on the splenocolic “criminal” ligament

Direct injury

Technical difficulties

Maneuvers

Slide By advancement

Hooking the flexure

Alpha maneuver

Straightening the sigmoid loop

External pressure

Biopsy

Polypectomy

Supine position

Operator inexperience

Patient Dependent

Decreased mobility of spleen and colon from adhesions

Splenomegaly

Inflammation

Inflammatory Bowel Disease

Diverticular disease

Pancreatitis

Infection

Malaria

Typhoid fever

Epstein-Barr virus-induced mononucleosis

Multiple colonoscopies

Prior surgery

Cancer

Anticoagulation