Understanding Kehr’s Sign: A Rare Complication of Colonoscopy

A colonoscopy is a standard, life-saving screening tool used to detect colorectal cancer and other gastrointestinal conditions. While the procedure is generally safe, rare complications can occur. One such clinical phenomenon is the presentation of referred pain—specifically left-sided clavicular pain—which may indicate a splenic injury, a rare but serious adverse event.

What is Kehr’s Sign?

Kehr’s sign is a classic medical indicator characterized by acute pain in the tip of the shoulder, often the left side. This pain is not originating in the shoulder itself. rather, it is “referred” pain. It occurs when blood or other irritants, such as air or digestive fluids, accumulate in the abdominal cavity and irritate the diaphragm. Because the phrenic nerve shares similar spinal nerve roots with the supraclavicular nerves that supply sensation to the shoulder, the brain misinterprets the abdominal irritation as pain in the shoulder.

While historically associated with a ruptured spleen, Kehr’s sign can be a warning sign of any intra-abdominal pathology that causes diaphragmatic irritation.

Splenic Injury During Colonoscopy

Although rare, splenic injury is a documented complication of colonoscopies. The spleen is anatomically attached to the colon by several ligaments. During a colonoscopy, excessive traction on these ligaments—often caused by difficult looping of the colonoscope or adhesions—can lead to a splenic tear or hematoma.

Patients who experience a splenic injury following a procedure may present with symptoms that go beyond typical post-colonoscopy bloating or mild cramping. These symptoms can include:

• Persistent or worsening abdominal pain.
• Left upper quadrant tenderness.
• Dizziness, lightheadedness, or signs of hypotension (low blood pressure).
• Referred pain in the left shoulder (Kehr’s sign).

Why Recognition Matters

Because post-colonoscopy discomfort is common, identifying the subtle signs of a serious injury is vital for both patients, and clinicians. If a patient reports pain radiating to the left shoulder after a colonoscopy, it should be treated as a clinical priority. Diagnostic imaging, such as a CT scan of the abdomen, is typically used to confirm the presence of a splenic injury or free fluid in the peritoneal cavity.

Key Takeaways for Patients

• Know the difference: Mild gas pain is expected after a colonoscopy, but sharp, persistent pain, especially in the abdomen or left shoulder, is not.
• When to seek help: If you experience severe abdominal pain, a rapid heart rate, or dizziness following your procedure, seek medical attention immediately.
• Clinical awareness: Kehr’s sign is a rare but critical clinical finding that can expedite the diagnosis of an abdominal emergency.

Conclusion

While the risk of splenic injury during a colonoscopy is statistically very low, it remains a serious condition that requires prompt medical intervention. Understanding the connection between abdominal irritation and referred shoulder pain is an essential part of post-procedural monitoring. If you have recently undergone a colonoscopy and are experiencing symptoms that feel “out of the ordinary,” do not hesitate to contact your gastroenterologist or visit an emergency department for a thorough evaluation.

Disclaimer: This article is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.