It has been reported that up to 40 % of all splenectomies are performed for iatrogenic injury. Excessive traction, injudicious use of retractors, and direct trauma during operations are typical mechanisms of injury. Splenic injury may occur in left hemicolectomy, open anti-reflux procedures, left nephrectomy, gastrectomy, and during exposure and reconstruction of the proximal abdominal aorta and its branches. The risk of injury to the spleen is higher in patients who have previously undergone abdominal surgery, in the elderly, and in obese patients.

Splenic injury is a rare complication of colonoscopy. However, given the increasing use of colonoscopy, it is worthy to be aware of this rare but potentially fatal complication of colonoscopy.

Splenic injury might also inadvertently occur during percutaneous nephrolithotomy. Ultrasound guidance during the procedure significantly reduces the risk of splenic injury. Cross-sectional imaging might be helpful in planning subcostal puncture by clarification of structures adjacent to the kidney. The possibility of splenic injury should be an immediate consideration in the event of hemodynamic instability after left-sided percutaneous nephrolithotomy.