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World J Gastroenterol. Jul 14, 2021; 27(26): 4143-4159
Published online Jul 14, 2021. doi: 10.3748/wjg.v27.i26.4143
Abdominal and gastrointestinal manifestations in COVID-19 patients: Is imaging useful?
Piero Boraschi, Luigi Giugliano, Giuseppe Mercogliano, Francescamaria Donati, Stefania Romano, Emanuele Neri
Piero Boraschi, Francescamaria Donati, Department of Diagnostic Imaging, Second Division of Radiology, Azienda Ospedaliero-Universitaria Pisana-University of Pisa, Pisa 56124, Italy
Luigi Giugliano, Giuseppe Mercogliano, Department of Radiology, University of Naples “Federico II”, Naples 80131, Italy
Stefania Romano, Department of Diagnostic Imaging, Santa Maria delle Grazie Hospital, Naples 80078, Italy
Emanuele Neri, Diagnostic and Interventional Radiology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa 56126, Italy
Author contributions: Boraschi P, Giugliano L, Mercogliano G and Donati F searched PubMed for relevant articles and contributed to writing, revising and submitting the manuscript; Romano S and Neri E co-authored and critically revised the manuscript; all authors approved the final version of the article.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors who contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Piero Boraschi, MD, Doctor, Department of Diagnostic Imaging, Second Division of Radiology, Azienda Ospedaliero-Universitaria Pisana-University of Pisa, via Paradisa 2, Pisa 56124, Italy. p.boraschi@gmail.com
Received: January 26, 2021
Peer-review started: January 26, 2021
First decision: March 29, 2021
Revised: April 8, 2021
Accepted: April 21, 2021
Article in press: April 21, 2021
Published online: July 14, 2021
Processing time: 166 Days and 13.7 Hours
Abstract

Coronavirus disease 2019 (COVID-19) can be considered a systemic disease with a specific tropism for the vascular system, in which the alterations of the microcirculation have an important pathogenetic role. The lungs are the main organ involved in COVID-19, and severe progressive respiratory failure is the leading cause of death in the affected patients; however, many other organs can be involved with variable clinical manifestations. Concerning abdominal manifestations, the gastrointestinal tract and the hepatobiliary system are mainly affected, although the pancreas, urinary tract and spleen may also be involved. The most common gastrointestinal symptoms are loss of appetite, followed by nausea and vomiting, diarrhea and abdominal pain. Gastrointestinal imaging findings include bowel wall thickening, sometimes associated with hyperemia and mesenteric thickening, fluid-filled segments of the large bowel and rarely intestinal pneumatosis and ischemia. Hepatic involvement manifests as an increase in the enzymatic levels of alanine aminotransferase, aspartate aminotransferase, serum bilirubin and γ-glutamyl transferase with clinical manifestations in most cases mild and transient. The most frequent radiological features are hepatic steatosis, biliary sludge and gallstones. Edematous acute pancreatitis, kidney infarct and acute kidney injury from acute tubular necrosis have been described more rarely in COVID-19. Lastly, splenic involvement is characterized by splenomegaly and by the development of solitary or multifocal splenic infarcts with classic wedge-shaped or even rounded morphology, with irregular or smooth profiles. In summary, the abdominal radiological findings of COVID-19 are nonspecific and with poor pathological correlation reported in the literature. Ultrasound and particularly computed tomography with multiphasic acquisition are the diagnostic methods mainly utilized in COVID-19 patients with abdominal clinical symptoms and signs. Although radiological signs are not specific of abdominal and gastrointestinal involvement, the diagnostic imaging modalities and in particular computed tomography are helpful for the clinician in the management, evaluation of the severity and evolution of the COVID-19 patients.

Keywords: COVID-19; SARS-CoV-2; Abdominal findings; Gastrointestinal findings; Computed tomography; Ultrasound

Core Tip: Coronavirus disease 2019 (COVID-19) pulmonary involvement has been extensively reported in the literature. Nowadays, a series of published data highlight how COVID-19 is a systemic disease affecting many other organs. Abdominal and gastrointestinal clinical manifestations have been more recently investigated with imaging modalities such as ultrasound and computed tomography. The aim of this review is to report the most common imaging features of abdominal and gastrointestinal involvement and the possible role of ultrasound and particularly computed tomography in the management, evaluation of the severity and evolution of COVID-19 patients.