Abdominal symptoms as initial manifestation of COVID-19: a case series

Abstract

The COVID-19 became a pandemic in early 2020. It was found, at first, that the main manifestations of this new virus occur through respiratory and constitutional symptoms. Therefore, chest tomography was elected as the best imaging test to assess the extent of pulmonary involvement and as a good prognostic predictor for the disease. However, as new studies were produced, the gastrointestinal involvement of COVID-19 becomes more evident, with reports from patients who manifested mainly or only gastrointestinal symptoms in the course of the disease. Thus, in some cases, the initial investigation is carried out at the emergency department with an abdominal computed tomography. We report a case series of ten patients who came to the emergency department of our institution with a chief gastrointestinal complaint, and were initially submitted to an abdominal computed tomography as the first investigation. Although most of the patients did not have significant changes in the abdominal images, most reported patients had pulmonary findings visualized at the lung bases, which were later designated as typical COVID-19 pulmonary findings on chest computed tomography. Only one patient had atypical COVID-19 lung changes on chest computed tomography. All patients had a positive real-time polymerase chain reaction for COVID-19. It is imperative to alert radiologists, especially abdominal radiologists, with the possibility of COVID-19 isolated gastrointestinal symptoms. Besides, it must become a habit to radiologists to assess the pulmonary basis on abdominal scans, a site commonly affected by the new coronavirus.

Coronavirus disease–2019 and the intestinal tract: An overview

“…COVID-19 is a potentially deadly disease, which can infect intestinal cells[ 13 ]. SARS-CoV-2 gastrointestinal infections[ 16 ] can generate diarrhea, pain, and vomiting[ 19 ]. To date, few reports have investigated the possible consequences of gastrointestinal infection by SARS-CoV-2; nevertheless, viral infections can alter the gastrointestinal microbiota[ 20 ].…”

“…The most frequent gastrointestinal symptoms in COVID-19 are diarrhea, nausea, abdominal pain, and lack of appetite[ 19 ]. After a viral gastrointestinal infection, some patients may develop alterations on the gastrointestinal microbiota such as an increase of Proteobacteria and a simultaneous reduction of Bacteriodetes[ 20 ].…”

Unusual presentation of coronavirus disease2019(COVID-19): two cases of acute abdomen

“…The symptoms include diarrhoea (8.1 -33.7%), nausea and vomiting (1.5 -26.4%), anorexia (12.1 -40.0%) and abdominal pain (0 -14.5%) [4]. In some cases, abdominal symptoms were the initial presentation of COVID-19 in the absence of the typical respiratory symptoms [9,12].…”

“…In COVID-19 cases that have proven abdominal pathologies it is plausible this may be due to the inflammation caused directly by the SARS-CoV-2. For instance, a case of enterocolitis diagnosed after CT scan findings of thickening of ascending colon and ileum could have been from COVID-19 or perhaps due to an intestinal co-infection [12]. In a report of gastrointestinal bleeding, SARS-CoV-2 was isolated from bleeding oesophageal ulcers, another possible direct cause [8].…”

Coronavirus Disease and Abdominal Pain: Mechanism, Diagnostic, and Treatment

“…However, various authors suggest that GI symptoms may be underestimated and indicate that abdominal pain, diarrhea, nausea, vomiting, and lack of appetite, in some cases are presented before [5] or together with mild respiratory symptoms. Zang et al [6] suggested that patients with GI symptoms had longer duration between symptom onset and viral clearance.…”