Published online Jul 27, 2021. doi: 10.4240/wjgs.v13.i7.702
Peer-review started: February 8, 2021
First decision: March 30, 2021
Revised: April 12, 2021
Accepted: July 2, 2021
Article in press: July 2, 2021
Published online: July 27, 2021
Processing time: 164 Days and 14.7 Hours
Coronavirus disease 2019 (COVID-19), an infectious condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since its first description in Wuhan in December 2019. Even though respiratory manifestations are the most prevalent and responsible for disease morbidity and mortality, extrapulmonary involvement has progressively gained relevance. In particular, gastrointestinal (GI) signs and symptoms, reported in up to two-thirds of patients with COVID-19, might represent the first and, in some cases, the only disease presentation. Their presence has been associated in some studies with an increased risk of a severe disease course. Proposed pathogenic mechanisms explaining GI tract involvement are either direct viral access to intestinal cells via angiotensin-converting enzyme 2 or indirect damage of the intestinal wall through mesenteric ischemia induced by the hypercoagulable state associated with COVID-19 infection. Although not typical of SARS-CoV-2 infection, several small bowel manifestations have been described in infected patients who underwent any form of abdominal imaging. The radiological findings were mainly reported in patients with abdominal symptoms, among which abdominal pain was the most common.
To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies.
Bibliographical searches were performed in PubMed, using the following keywords: “COVID-19” AND “imaging” AND “gastrointestinal” OR “abdominal” OR “small bowel”.
Of 62 patients with described radiologic small bowel alterations, mesenteric ischemia was diagnosed in 31 cases (50%), small bowel wall thickening in 10 cases (16%), pneumatosis in nine cases (15%), intussusception in eight cases (13%), pneumoperitoneum in two cases (3%) and paralytic ileus in two cases (3%). We also reported mesenteric adipose tissue hypertrophy and lymph nodes enlargement in a young woman.
So far it is difficult to establish whether these manifestations are the direct consequence of SARS-CoV-2 infection or collateral findings in infected patients, but their recognition would be pivotal to set a closer follow-up and to reduce missed diagnoses.
Core Tip: Gastrointestinal manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been increasingly reported and corresponding abdominal imaging findings have been recognized. The present review includes case reports, case series, and retrospective studies discussing small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies. Out of 62 patients, the most commonly reported finding was mesenteric ischemia, with a prevalence of 50%. Other less frequent features were small bowel wall thickening (16%), pneumatosis intestinalis (15%), intussusception (13%), pneumoperitoneum (3%), and paralytic ileus (3%). We also report a patient with mesenteric adipose tissue hypertrophy and lymph node enlargement.