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

Table 1 Clinical characteristics and radiological findings of acute mesenteric ischemia in coronavirus disease-2019 patients

Ref.	Patients, n	Age in yr	Gender	GI symptoms	Respiratory symptoms	Relevant laboratory test	Imaging modality	Radiological findings	Treatment	Outcome
de Barry et al[17]	1	79	F	Abdominal pain, diarrhea	Yes	WBC 12.6 × 109/L; CRP 125 mg/L	CT	Mesenteric ischemia; upper mesenteric vein and portal thrombosis; upper mesenteric artery and jejunal artery thrombosis	Laparotomy with segmental resection; thrombolysis and thrombectomy	Dead 4 d after surgery
Beccara et al[18]	1	52	M	Abdominal pain, diarrhea, vomiting	Yes	WBC 30 × 109/L; CRP 222 mg/L	CT	Mesenteric ischemia; upper mesenteric artery thrombosis	Laparotomy with segmental resection; anticoagulant; antiaggregant	NR
Ofosu et al[19]	1	55	M	NR	Yes	WBC 9.5 × 109/L; CRP 3 mg/L; D-dimer 440 ng/mL	CT	Mesenteric ischemia; portal vein thrombosis	Anticoagulant	Discharged
La Mura et al[20]	1	72	M	NR	No	WBC 19.76 × 109/L (n 81%); CRP 172.3 mg/L	CT	Mesenteric ischemia; portal vein thrombosis	Anticoagulant	Discharged
Del Hoyo et al[21]	1	61	F	Abdominal pain, vomiting	No	CRP 9.43 mg/L; D-dimer 43.998 ng/mL	CT	Mesenteric ischemia; spleen-portal vein and hepatic vein thrombosis	Anticoagulant	Dead
Karna et al[22]	1	61	F	Abdominal pain, distension	Yes	NR	CT	Mesenteric ischemia; upper mesenteric artery thrombosis	Laparotomy with segmental resection; anticoagulant; antiaggregant	Dead 36 h after surgery
Cheung et al[23]	1	55	M	Abdominal pain, diarrhea, nausea	NR	NR	CT	Mesenteric ischemia; upper mesenteric artery thrombosis	NR	NR
de Roquetaillade et al[24]	1	NR	NR	NR	NR	NR	CT	Mesenteric ischemia	NR	NR
Vartanoglu et al[25]	5	NR	M	NR	Yes	WBC 8.67 × 109/L (mean); CRP 970 mg/L (mean); D-dimer 447 ng/mL (mean); Fib 6245 mg/dL (mean)	NR	Mesenteric ischemia	NR	1 patient dead
Fraissé et al[26]	3	NR	NR	NR	NR	NR	NR	Mesenteric ischemia	NR	NR
Ignat et al[27]	1	28	F	Abdominal pain, vomiting	No	NR	CT	Mesenteric ischemia; upper mesenteric vein and portal vein thrombosis	Laparotomy with segmental resection	NR
Pang et al[28]	1	30	M	Abdominal pain, vomiting	No	D-dimer 20000 ng/mL; Fib 465 mg/dL	CT	Mesenteric ischemia; upper mesenteric vein thrombosis	Laparotomy with segmental resection; anticoagulant	Discharged
Bianco et al[29]	1	59	M	Abdominal pain, nausea	Yes	NR	CT	Mesenteric ischemia; peritoneal free fluid	Laparotomy with segmental resection	Dead 4 d after surgery
Norsa et al[30]	3	79	F	Abdominal pain	NR	D-dimer 8 × ULN	CT	Mesenteric ischemia	NR	NR
		62	M	Abdominal pain, vomiting	NR	D-dimer 76 × ULN	CT	Mesenteric ischemia; upper mesenteric vein thrombosis	NR	Dead
		83	F	Abdominal pain	NR	D-dimer 3 × ULN	CT	Mesenteric ischemia	NR	Dead
Collange et al[31]	1	56	M	NR	NR	D-dimer 2260 ng/mL; Fib 113 mg/dL	CT	Mesenteric ischemia; mesenteric intravenous air	Laparotomy with segmental resection; anticoagulant	NR
Vulliamy et al[32]	1	75	M	Abdominal pain, vomiting	Yes	WBC 18 × 109/L; D-dimer 32000 ng/mL	CT	Mesenteric ischemia; embolic occlusion of upper mesenteric artery	Laparotomy with segmental resection; thrombectomy	NR
Rodriguez-Nakamura et al[33]	2	45	M	Abdominal pain	Yes	WBC 16.6 × 109/L (n 86%); CRP 367 mg/L; D-dimer 1450 ng/mL; Fib 579 mg/dL	CT	Mesenteric ischemia; upper mesenteric thrombosis	Laparotomy with segmental resection; anticoagulant	Discharged
		42	F	Abdominal pain	Yes	WBC 18.8 × 109/L (n 83.5%); CRP 239 mg/L; D-dimer 14.407 ng/mL; Fib 338 mg/dL	CT	Mesenteric ischemia; mesenteric veins and portal vein thrombosis	Laparotomy with segmental resection	Dead 48 h after surgery
E English et al[34]	1	40	M	Abdominal distension	Yes	Fib 548 mg/dL	CT	Mesenteric ischemia	Laparotomy and laparoscopy with segmental resection	Dead 48 h after surgery
Helms et al[35]	1	NR	NR	NR	NR	NR	CT	Mesenteric ischemia	NR	NR
Mitchell et al[36]	1	69	M	Abdominal pain, constipation, eructation	NR	NR	CT	Mesenteric ischemia; upper mesenteric artery thrombosis	Laparotomy with segmental resection; thrombolysis and thrombectomy	Discharged
Azouz et al[37]	1	56	M	Abdominal pain, vomiting	No	NR	CT	Mesenteric ischemia; upper mesenteric thrombosis	Laparotomy with segmental resection; anticoagulant	NR
Franco-Moreno et al[38]	1	27	M	Abdominal pain	Yes	WBC 18 × 109/L (n 85%); CRP 245 mg/L; D-dimer 9530 ng/mL; Fib > 500 mg/dL	CT	Mesenteric ischemia; portal vein thrombosis	Anticoagulant	Discharged

CRP: C-reactive protein; CT: Computed tomography; Fib: Fibrinogen; N: Neutrophil; NR: Not reported; RX: Radiography; US: Ultrasound; WBC: White blood cell.

Table 2 Other small bowel radiological findings in coronavirus disease-2019 patients and relevant clinical characteristics

Ref.	Patients, n	Age in yr	Gender	GI symptoms	Imaging modality	Radiological findings	Other relevant information
Hellinger et al[40]	1	64	NR	Abdominal pain, nausea, vomiting, diarrhea, fever	CT	Small bowel thickening and hyperemia	-
Bhayana et al[12]	5	18-99	NR	Abdominal pain, nausea, vomiting, diarrhea, fever	CT	Small bowel thickening	100% of patients needed ICU
Goldberg-Stein et al[13]	2	NR	NR	NR	CT	Small bowel thickening	-
Periyakaruppan et al[41]	1	NR	M	Abdominal pain, diarrhea	CT	Small bowel thickening	Complete recovery after 2 d from I.V. immunoglobulin infusion
Guo et al[42]	1	29	M	Diarrhea, fever	CT	Small bowel thickening	-
Bhayana et al[12]	4	18-99	NR	Abdominal pain, nausea, vomiting, diarrhea, fever	CT	Pneumatosis intestinalis	20% of patients needed ICU.100% of patients underwent laparotomy
Tirumani et al[48]	1	NR	NR	NR	CT	Pneumatosis intestinalis; portal venous gas	-
Kielty et al[49]	1	47	M	Vomiting	CT	Pneumatosis intestinalis; peritoneal free fluid	The patient needed ICU. No need of surgery. Discharged
Di Grezia et al[50]	3	NR	NR	NR	CT	Pneumatosis intestinalis	Needed surgical intervention with open abdomen and negative pressure therapy (no need of intestinal resection)
Makrinioti et al[54]	2	10-mo	F	Crying, vomiting, red currant jelly-like stool	US	Ileocolic intussusception	Dead
		10-mo	F	Bilious vomiting, red currant jelly-like stool	NR	Intussusception	Recovered after surgery
Rajalakshmi et al[55]	1	8-mo	M	Vomiting, blood-stained stools	US	Intussusception	Recovered after surgery
Moazzam et al[56]	1	4-mo	M	Abdominal pain	US	Intussusception with "doughnut sign"	Recovered after surgery
Bazuaye-Ekwuyasi et al[57]	1	9-mo	M	Abdominal pain, vomiting, decreased oral intake, and blood-streaked stool	RX	Intussusception with "target" sign	Recovered after surgery
					US
Cai et al[58]	1	10-mo	F	Vomiting, currant jelly-like stool	US	Intussusception	Dead
Martínez-Castaño et al[59]	1	6-mo	M	Vomiting, abdominal cramps, currant jelly stools	US	Ileocolic intussusception	Discharged
Lu et al[60]	1	10-mo	NR	NR	NR	Intussusception	Dead

CT: Computer tomography; ICU: Intensive care unit; NR: Not reported; RX: Radiography; US: Ultrasound.