Splenic rupture is an extremely rare complication of
colonoscopy. So far, less than 80 cases have been reported worldwide since 1970. We report two patients, one patient presenting with haemorrhagic shock after a therapeutic colonoscopy and another patient presenting with abdominal pain following a diagnostic colonoscopy. In both cases splenic rupture was diagnosed by abdominal computed tomography (CT scan). One patient was treated by selective embolisation of the splenic artery; the other patient underwent a splenectomy. Because the numbers of colonoscopies performed in the Netherlands as well as in many other European countries are likely to double in the coming years as a result of the introduction of nationwide colorectal cancer screening programmes and intensive surveillance protocols after polypectomy, more splenic injuries as a complication of colonoscopy can be expected in the near future. Awareness of this complication is of great importance in early recognition and management of this potentially life-threatening injury.