Abdominal Computed Tomography Findings among COVID-19 Patients with Index Gastrointestinal Manifestations: A Preliminary Single-center Experience
Ranjan K Patel, Shruti Mittal, Taraprasad Tripathy
Citation Information :
Patel RK, Mittal S, Tripathy T. Abdominal Computed Tomography Findings among COVID-19 Patients with Index Gastrointestinal Manifestations: A Preliminary Single-center Experience. Euroasian J Hepatogastroenterol 2021; 11 (2):76-80.
Background: About 20% of COVID-19 patients can have digestive symptoms, apart from the typical chest-related symptoms, and 10% of patients may have only gastrointestinal (GI) symptoms during their entire disease course.
Aim and objective: The purpose of this study was to describe the spectrum of abdominal computed tomographic (CT) findings in a cohort of 15 COVID-19 patients (confirmed on reverse transcription polymerase chain reaction (RT-PCR)) who presented with various GI presentations without preceding respiratory symptoms.
Materials and methods: A total of 93 patients with COVID-19 (confirmed on RT-PCR) who underwent CT imaging (between September 28, 2020 and March 20, 2021) in our center were retrospectively searched from the existing database. Among those, 15 patients having index presentation with abdominal symptoms and underwent CT abdomen were further evaluated.
Results: Biliary stasis in the form of distended gallbladder and wall thickening was the most common finding, seen in 66.7% (n = 10) patients, followed by bowel wall thickening. Small bowel and large bowel thickenings were seen in 26.7% (n = 4) and 20% (n = 3) patients, respectively. Other findings include fluid-filled colon (n = 1), mesenteric venous thrombosis (MVT) (n = 2), paper-thin bowel wall and pneumatosis (n = 1), acute pancreatitis (n = 1), and ascites (n = 2). One patient who presented with abdominal pain did not show any obvious imaging findings on CT.
Conclusion: Patients with COVID-19 can present with initial GI symptoms preceding typical respiratory symptoms. CT imaging helps in identifying the GI involvement, to rule out alternate etiologies, and also aids in appropriate management planning.
Shimizu K. 2019-nCoV, fake news, and racism. Lancet 2020;395(10225):685–686. DOI: 10.1016/S0140-6736(20)30357-3.
Mao R, Qiu Y, He JS, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020;5(7):667–678. DOI: 10.1016/S2468-1253(20)30126-6.
Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol 2020;115(5):766–773. DOI: 10.14309/ajg.0000000000000620.
Zhong P, Xu J, Yang D, et al. COVID-19-associated gastrointestinal and liver injury: clinical features and potential mechanisms. Signal Transduct Target Ther 2020;5(1):1–8. DOI: 10.1038/s41392-020-00373-7.
Wong SH, Lui RN. Sung JJ. Covid-19 and the digestive system. J Gastroenterol Hepatol 2020;35(5):744–748. DOI: 10.1111/jgh.15047.
Bhayana R, Som A, Li MD, et al. Abdominal imaging findings in COVID-19: preliminary observations. Radiology 2020;297(1):E207–E215. DOI: 10.1148/radiol.2020201908.
Balaphas A, Gkoufa K, Meyer J, et al. COVID-19 can mimic acute cholecystitis and is associated with the presence of viral RNA in the gallbladder wall. J Hepatol 2020;73(6):1566. DOI: 10.1016/j.jhep.2020.08.020.
Iba T, Levy JH, Levi M, et al. Coagulopathy in COVID-19. J Thromb Haemost 2020;18(9):2103–2109. DOI: 10.1111/jth.14975.
Revzin MV, Raza S, Srivastava NC, et al. Multisystem imaging manifestations of COVID-19, part 2: from cardiac complications to pediatric manifestations. Radiographics 2020;40(7):1866–1892. DOI: 10.1148/rg.2020200195.
Parry AH, Wani AH, Yaseen M. Acute Mesenteric Ischemia in Severe Coronavirus-19 (COVID-19): Possible Mechanisms and Diagnostic Pathway. Acad Radiol. 2020;27(8):1190. DOI: 10.1016/j.acra.2020.05.016.
Barrett LF, Lo KB, Stanek SR, et al. Self-limited gastrointestinal bleeding in COVID-19. Clin Res Hepatol Gastroenterol 2020;44(4):e77. DOI: 10.1016/j.clinre.2020.06.015.
Sanku K, Siddiqui AH, Paul V, et al. An unusual case of gastrointestinal bleeding in a patient with COVID-19. Cureus 2021;13(3). DOI: 10.7759/cureus.13901.
Goldberg-Stein S, Fink A, Paroder V, et al. Abdominopelvic CT findings in patients with novel coronavirus disease 2019 (COVID-19). Abdom Radiol 2020;45(9):2613–2623. DOI: 10.1007/s00261-020-02669-2.
Wang F, Wang H, Fan J, et al. Pancreatic injury patterns in patients with coronavirus disease 19 pneumonia. Gastroenterology 2020;159(1):367–370. DOI: 10.1053/j.gastro.2020.03.055.