Global Reports of Intussusception in Infants With SARS-CoV-2 Infection

Abstract

Idiopathic intussusception is a common cause of bowel obstruction in infants, presenting as refractory abdominal pain or mass, vomiting, lethargy, and currant jelly stool. Coronavirus disease 2019 is not well characterized in children, especially infants, but symptoms in children have included nausea, vomiting, diarrhea, and abdominal pain. From January to July 2020, intussusception was reported in 5 infants 4–10 months of age who had laboratory-confirmed SARS-CoV-2 infection. All 5 infants presented with currant jelly stool and at least 1 other abdominal symptom, and none presented with respiratory symptoms. Four infants recovered but the fifth infant progressed to a critical illness and death. While an association between SARS-CoV-2 infection and intussusception has not been established, infants with symptoms consistent with intussusception may warrant testing for viral pathogens, including SARS-CoV-2, especially if presenting to healthcare with a history of SARS-CoV-2 exposure or with signs and symptoms of COVID-19. More investigation is needed to determine whether intussusception is part of the clinical spectrum of COVID-19 in infants or a coincidental finding among infants with SARS-CoV-2 infection.

COVID-19 presenting as intussusception in infants: A case report with literature review

“…SARA-COV-2 could be presented with sever inflammatory condition known as cytokines storm, which is mainly originated from respiratory tract, but the exclusive presence of gastrointestinal symptoms with the absence of respiratory symptoms in several positively tested adults [ 30 ] and children [ 13 , 31 ] might suggest that the cytokines storm could be originated from the Gastro intestinal tract (GIT) causing GIT symptoms and complications including intussusception, where a significant association was found between acute intussusception in paediatric and high-level of circulating inflammatory cytokines and plasma CRP [ 32 ]. This hypothesis could be explained by the fact that the intestine has large number of mesenteric lymph nodes and Peyer patches, activated T cells, mast cells, plasma cells and macrophages, and during infection lymphadenopathy and hypertrophy of Peyer patches is taking places causing intussusception [ 20 ].…”

Intussusception and SARS-CoV-2 infection

“…COVID-19 in children, specifically infants, has an asymptomatic or mild presentation. Gastrointestinal symptoms have been more frequent in pediatric age compared to adults, and include nausea, vomiting, diarrhea, and abdominal pain [ 2 ]. To date, available studies show that approximately 10% of pediatric patients present these symptoms and they have been associated with greater severity of the disease [ 5 ].…”

“…Intussusception or intestinal invagination occurs when a segment of the intestine (the intusuceptum) is telescopically introduced into an adjacent segment (intussuscipiens) [ 1 ]. It is the most common cause of intestinal obstruction in infants [ 2 ]. Surgical reduction is performed urgently in order to avoid the development of ischemia, necrosis, perforation and peritonitis.…”

Intussusception in an Infant With SARS-CoV-2 Infection: A Case Report and a Review of the Literature

“…The most frequent form in pediatric age is the ileocolic (80%), followed by rare ileoileal and colocolic forms ( 1 ). Viral infections have been described as associated with this condition ( 2 ).…”

“…However, it is now evident that SARS-CoV-2 can also affect the gastrointestinal system, with the highest incidence in pediatric age ( 4 ). Sporadic cases of intussusception in SARS-CoV-2 infected children have been reported worldwide ( 2 ).…”