Left Clavicular Pain Following Splenic Rupture After Colonoscopy: A Variant of Kehr's Sign?

Colonoscopy is a widely performed diagnostic and therapeutic procedure in modern gastrointestinal practice and is generally considered safe. However, splenic injury remains a rare but potentially life-threatening complication. We present the case of a 67-year-old woman who developed severe epigastric and left-sided pain six days following an uncomplicated colonoscopy. Notably, the patient reported pain localised to the left clavicular region rather than the classical left shoulder-tip pain associated with Kehr's sign. She also experienced a syncopal episode and presented with hypotension and tachycardia. Computed tomography imaging confirmed splenic rupture with haemoperitoneum. The patient underwent emergency exploratory laparotomy and total splenectomy, with evacuation of approximately 1.1 litres of blood and 700 mL of clots. She required a blood transfusion and postoperative intensive care monitoring but made an uneventful recovery. This case highlights the importance of recognising atypical or imprecisely localised referred pain in splenic injury. While clavicular pain may represent a variation of Kehr's sign due to diaphragmatic irritation, clinicians should interpret such distinctions cautiously. A high index of suspicion is essential for early diagnosis and management.