Colonoscopies are usually regarded as safe procedures with low complication rates and are recommended for anyone over the age of fifty for colon cancer screening. Splenic rupture is a rare complication of colonoscopy with few reported cases in the English literature. We present the only reported case of such a complication in the state of Hawai'i and the 44th reported case in the English literature. Physicians need to be more aware of the possibility of splenic rupture following colonoscopy to avoid delay of diagnosis and treatment of this life-threatening complication.