Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature

Abstract

BACKGROUND 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. AIM To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies. METHODS Bibliographical searches were performed in PubMed, using the following keywords: “COVID-19” AND “imaging” AND “gastrointestinal” OR “abdominal” OR “small bowel”. RESULTS 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. CONCLUSION 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.

Isquemia mesentérica em paciente com Miomatose uterina em tratamento com anticoncepcional oral combinado: Um relato de caso

“…A IM é considerada um evento incomum, suas principais causas são: embolia arterial mesentérica aguda causada por fibrilação atrial, trombose da artéria mesentérica superior em antecedentes de doença aterosclerótica crônica pré-existente e isquemia mesentérica não oclusiva secundária à vasoconstrição da artéria mesentérica superior 9 .…”

“…Leiden e mutações de protrombina. Deficiência de proteína S e C, e outras, promovem trombose venosa mesentérica e têm sido descritas na literatura como agentes causadores de IM 9 .…”

Isquemia mesentérica y covid-19. Reporte de caso

“…Although the authors do not describe a clear explanation (2), they propose as possible hypotheses, the participation of the thrombogenic effect of COVID-19 or the possible dietary changes during the pandemic. To date, there is some data on mesenteric ischaemia in COVID-19, extracted from several published cases and grouped through systematic reviews (3,4).…”

The small intestine phlegmon in a patient with a new coronavirus infection

“…Поражение брыжеечных сосудов у пациентов с COVID-19 может предрасполагать к развитию ишемии кишечника с последующим переходом в гангрену [10][11][12][13]. Среди возможных причин развития ишемии кишечника на фоне COVID-19 следует назвать острую эмболию брыжеечной артерии, неокклюзионную ишемию брыжейки и острый тромбоз брыжеечной вены [10][11][12][13][14][15].…”