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

摘要

BACKGROUND Coronavirus disease 2019(COVID-19),an infectious condition caused by severe acute respiratory syndrome coronavirus 2(SARS-Co V-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-Co V-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-Co V-2 infection in abdominal imaging studies.METHODS Bibliographical searches were performed in Pub Med,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-Co V-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.