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) is an infectious disease with predominant respiratory symptoms. Yet extrapulmonary manifestations have been increasingly recognized in COVID-19 patients. In particular, gastrointestinal (GI) symptoms are reported in up to two-thirds of patients and might be the only manifestations in some cases.
Given the high prevalence of gastrointestinal involvement of COVID-19 and the unclear association with disease clinical outcome, we believe that it could be of interest to deeply investigate small bowel involvement in severe acute respiratory syndrome coronavirus 2 infection.
To analyze and to summarize small bowel radiological features described in COVID-19 patients, and possibly clarify their impact on the clinical management of COVID-19 patients presenting with GI symptoms.
A literature search of the PubMed electronic database was conducted using the MeSH terms “COVID-19”, “imaging” and “gastrointestinal” or “abdominal” or “small bowel”. The search was limited to English-language papers. All available case reports, case series and retrospective studies between December 2019 and January 2021 were included.
AMI is the major radiological finding in COVID-19 patients with small bowel involvement (50%). Less common findings are thickening of the small bowel wall, pneumatosis intestinalis, intussusception, and paralytic ileus. Furthermore, we described a case of mesenteric adipose tissue hypertrophy and enlarged lymph nodes associated to COVID-19.
Gastrointestinal involvement in COVID-19 patients is highly prevalent. The most frequent small bowel alteration is AMI, a condition associated with high mortality. Raised awareness and prompt identification of small bowel involvement in COVID 19-patients could be essential to improve clinical management and clinical outcome, mainly in case of AMI.
Further investigation of abdominal imaging abnormalities in COVID-19 patients may be a topic for future research and could help in reducing missed diagnoses and benefit overall morbidity and mortality.