A 76-year-old woman underwent colonoscopy with biopsy of a 1-mm cecal polyp and biopsy of a 1.5-cm ileal nodule 10cm from the ilealcecal valve. Biopsies where taken without evidence of postbiopsy bleeding. The patient was in her usual state of health before the procedure. Her medical history is significant for endometrial cancer treated with total abdominal hysterectomy and bilateral oophorectomy (TAH-BSO), a large hiatal hernia, and cecal tubular adenoma removed endoscopically. Her history is negative for any known disease process involving the spleen. Thirty minutes after this colonoscopy, she was found to be hypotensive, with a systolic blood pressure of 71 over a diastolic pressure of 51, diaphoretic, pale, and nervous. She was admitted to the intensive care unit with a hemoglobin level of 8.4g/dL and a hematocrit of 25%, placed on norepinephrine to support her blood pressure, and transfused with packed red blood cells. 
The surgical service was asked to consult the following day, after she remained hypotensive, required multiple blood transfusions, and had a computed tomographic (CT) scan that showed massive hemoperitoneum (Figure 1). At this time, she was taken for emergency laparotomy, during which she was found to have splenic rupture with avulsion of the splenic capsule and splenocolic ligaments. She underwent splenectomy. The spleen was a normal size, measuring 54 g with no pathology found on gross or microscopic examination. Postoperatively, she did well and was transferred from the intensive care unit to a regular surgical floor on postoperative day 2.