Splenic rupture following colonoscopy (SRFC) is a rare complication and can have associated mortality if left undiagnosed. Most of the cases reported have been managed operatively. Here, we present a case of a 75-year-old-female who underwent conservative management for SRFC. Splenic rupture should remain a differential in patients presenting with abdominal pain, syncope, and hypotension following colonoscopy. Decisions regarding operative versus conservative management should be guided by the patient’s clinical status, hemodynamics, and available resources.
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