Pirola L, Palermo A, Mulinacci G, Ratti L, Fichera M, Invernizzi P, Viganò C, Massironi S. Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature. World J Gastrointest Surg 2021; 13(7): 702-716 [PMID: 34354803 DOI: 10.4240/wjgs.v13.i7.702]
Corresponding Author of This Article
Chiara Viganò, MD, Doctor, Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, Monza 20900, Italy. c.vigano@hotmail.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2021; 13(7): 702-716 Published online Jul 27, 2021. doi: 10.4240/wjgs.v13.i7.702
Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature
Lorena Pirola, Andrea Palermo, Giacomo Mulinacci, Laura Ratti, Maria Fichera, Pietro Invernizzi, Chiara Viganò, Sara Massironi
Lorena Pirola, Andrea Palermo, Giacomo Mulinacci, Laura Ratti, Maria Fichera, Pietro Invernizzi, Chiara Viganò, Sara Massironi, Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
Lorena Pirola, Andrea Palermo, Giacomo Mulinacci, Laura Ratti, Maria Fichera, Pietro Invernizzi, Chiara Viganò, Sara Massironi, European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
Author contributions: Pirola L and Viganò C planned the work; Pirola L, Viganò C and Massironi S contributed to the design and conceptualization of the study; Palermo A and Mulinacci G wrote the first draft of the manuscript and edited the figures and tables; Pirola L, Ratti L, Fichera M and Viganò C edited the subsequent versions of the manuscript; Viganò C and Massironi S revised the manuscript for relevant intellectual content; Invernizzi P corrected the final version; all the authors read and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chiara Viganò, MD, Doctor, Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, Monza 20900, Italy. c.vigano@hotmail.it
Received: February 8, 2021 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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
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.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
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.
