Pirola Lorena, Palermo Andrea, Mulinacci Giacomo, Ratti Laura, Fichera Maria, Invernizzi Pietro, Viganò Chiara, Massironi Sara
Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy.
World J Gastrointest Surg. 2021 Jul 27;13(7):702-716. doi: 10.4240/wjgs.v13.i7.702.
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 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.
To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies.
Bibliographical searches were performed in PubMed, using the following keywords: "COVID-19" AND "imaging" AND "gastrointestinal" OR "abdominal" OR "small bowel".
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.
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.
2019冠状病毒病（COVID-19）是由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的一种感染性疾病，自2019年12月在武汉首次被发现以来，已在全球迅速传播。尽管呼吸道表现最为常见，且是疾病发病和死亡的主要原因，但肺外受累问题也日益受到关注。特别是，高达三分之二的COVID-19患者报告有胃肠道（GI）体征和症状，这可能是疾病的首发表现，在某些情况下甚至是唯一表现。在一些研究中，它们的出现与严重病程风险增加有关。解释胃肠道受累的潜在致病机制要么是病毒直接进入肠道细胞（血管紧张素转换酶2），要么是通过与COVID-19感染相关的高凝状态引起的肠系膜缺血对肠壁造成间接损害。虽然这些表现并非SARS-CoV-2感染的典型症状，但在接受任何形式腹部影像学检查的感染患者中，已发现了一些小肠表现。影像学检查结果主要报告于有腹部症状的患者，其中腹痛最为常见。
探讨腹部影像学检查中SARS-CoV-2感染的小肠影像学表现。
在PubMed上进行文献检索，使用以下关键词：“COVID-19”、“影像学”、“胃肠道”或“腹部”或“小肠”。
在62例有小肠影像学改变的患者中，诊断出肠系膜缺血31例（50%），小肠壁增厚10例（16%），肠壁积气9例（15%），肠套叠8例（13%），气腹2例（3%），麻痹性肠梗阻2例（3%）。我们还报告了一名年轻女性的肠系膜脂肪组织肥大和淋巴结肿大。
目前尚难以确定这些表现是SARS-CoV-2感染的直接后果还是感染患者的附带发现，但认识到这些表现对于加强密切随访和减少漏诊至关重要。
