Splenic injury following colonoscopy
I agree with the authors that splenic injury following colonoscopy has been under-reported and is likely to increase with an on-going National Bowel Screening Programme.

In this particular case, re-anticoagulation with warfarin seems to be one of the predisposing factors causing secondary bleed. The spleen was found to be shattered with very little enhancing tissue on the computed tomography scan high-lighting that injury was due to traction injury to the atheromatous splenic vessels rather than the capsular tear as seen in our case report.1 Although possible mechanisms of injury have been postulated in this case report and previous publications,1 the type of injury to the spleen (capsular or vessel) will help delineate the exact mode of injury to the spleen.

It leaves the dilemma of whether splenic trauma should be mentioned on the consent form as a complication of colonoscopy. The true incidence remains unknown as authors have high-lighted that it may remain undiagnosed or be misdiagnosed as post-colonoscopy discomfort.