In a new study, researchers found that many patients with COVID-19 can have bowel abnormalities, including ischemia.
The research was conducted by a team at Massachusetts General Hospital.
Several studies have evaluated the chest imaging findings in COVID-19, which helped improve understanding of how the disease affects the lungs.
More recently, reports have documented that gastrointestinal symptoms, liver injury, and vascular findings are common in these patients.
However, abdominal imaging findings have not yet been widely reported. Imaging findings may help physicians understand abdominal manifestations in patients with the infection.
Therefore, the team of this study set out to explore abdominal imaging findings in patients with COVID-19.
The study included 412 patients admitted to a single quaternary care center from March 27 to April 10, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Records showed that 17% of patients had cross-sectional abdominal imaging, including 44 ultrasounds, 42 CT scans, and 1 MRI.
Bowel abnormalities were seen on 31% of CT scans (3.2% of all patients) and were more frequent in intensive care unit (ICU) patients than other inpatients.
Bowel findings included thickening and findings of ischemia such as pneumatosis (gas in the bowel wall) and portal venous gas.
Surgical correlation in four patients revealed unusual yellow discoloration of bowel in three of the patients, and bowel infarction (dead bowel) in two patients.
The team says they found bowel abnormalities on imaging in patients with COVID-19, more commonly in sicker patients who went to the ICU.
In two patients who had bowel resection, pathology demonstrated ischemia with patchy necrosis (injury due to reduced arterial flow with patchy areas of cell death).
Both had fibrin thrombi (blood clots) in submucosal arterioles (small arteries in the bowel wall), suggesting bowel ischemia in these patients might be caused by these small blood clots.
Of right upper quadrant ultrasounds, 87% were performed for liver laboratory findings, and 54% demonstrated a dilated sludge-filled gallbladder suggestive of cholestasis, or a decrease in bile flow.
The team says some findings were typical of bowel ischemia, or dying bowel, and in those who had surgery we saw small vessel clots beside areas of dead bowel.
Patients in the ICU can have bowel ischemia for other reasons, but we know COVID-19 can lead to clotting and small vessel injury, so bowel might also be affected by this.
According to the researchers, possible explanations for the spectrum of bowel findings in patients with COVID-19 include direct viral infection, small vessel thrombosis, or nonocclusive mesenteric ischemia.
One author of the study is Rajesh Bhayana, M.D., FRCPC, abdominal imaging fellow in the Department of Radiology at Massachusetts General Hospital in Boston.
The study is published in the journal Radiology.
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