Abdominal Radiologists Stay Alert: Some COVID-19 Patients Present with GI Symptoms Only

Close to 20 percent of COVID-19-positive patients present with abdominal symptoms alone. Consequently, a new article recommends, abdominal radiologists need to keep their eyes open so they can identify patients who might be infected.

Although fever, fatigue, cough, and respiratory difficulties are considered the hallmark signs of COVID-19 infection, approximately 18 percent of patients show up with complaints of appetite loss, nausea, vomiting, diarrhea, and abdominal gas. In fact, according to a team of investigators from the University of Alberta, 16 percent of patients present with only these abdominal symptoms.

They published the results of their literature review, including findings from published studies and case reports, in the Sept. 14 Abdominal Radiology. 

“Gastrointestinal manifestations of COVID-19 have been increasingly recognized,” said the team led by Kevin Lui from the University of Alberta radiology and diagnostic imaging department, noting that the findings are rare, but varied.

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For their review, Lui’s team analyzed 36 published studies that examined how COVID-19 has manifested on abdominal imaging. The studies were published between March 31, 2020, and July 15, 2020.

According to their analysis, the most common findings included small and large bowel wall thickening, fluid-filled colon, pneumatosis intestinalis, pneumoperitoneum, intussusception, and ascites. In many cases, they said, radiologists will pick up on them in abdominal CT scans as incidental findings that show up in the base of the lungs.

In fact, some studies specifically recommended that radiologists pay careful attention to the lung bases to catch any possible COVID-19 cases. In addition, the team added, the features highlighted in this study can be used a cues for imaging experts to consider a COVID-19 diagnosis, particularly when the patient does not have typical symptoms associated with the virus.

“Identifying these features on abdominal imaging highlight the need to consider and evaluate for other manifestations of COVID-19, such as lung parenchymal findings,” the team said. “In the appropriate setting, COVID-19 can be raised as a consideration, particularly in patients presenting with atypical symptoms.”

Based on their findings, the team pointed to the need for future investigations into abdominal imaging abnormalities in COVID-19 cases that present with both respiratory and gastrointestinal symptoms.