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A 64-year-old male presented to the emergency\uddepartment (ED) with near syncope and worsening left flank\udand shoulder pain. He had undergone a difficult colonoscopy\udtwo days prior due to a tortuous colon. Initial vital signs\udwere normal. He looked uncomfortable and had significant\udleft upper quadrant abdominal tenderness with guarding.\udThirty minutes after ED arrival, his blood pressure dropped\udto 73/59 mmHg, requiring aggressive fluid resuscitation.\udBedside focused assessment with sonography in trauma\ud(FAST) exam demonstrated free fluid in the abdomen with\udmixed echogenicity of the spleen, suggestive of splenic injury.\udComputed tomography (CT) demonstrated a large subcapsular\udsplenic hematoma with active extravasation and surrounding\udintraperitoneal free fluid (Figure, Video). He was admitted to\udthe surgical intensive care unit. Hemorrhage continued after\udinterventional radiology performed embolization of the splenic\udartery. He then required laparoscopic splenectomy on hospital\udday 2 to control bleeding. He subsequently did well and was\uddischarged on hospital day 10

Splenic Rupture Diagnosed with Bedside Ultrasound in a Patient with Shock in the Emergency Department Following Colonoscopy