Intussusception in a child with COVID-19 in the USA

Intussusception and COVID-19 in Children: A Systematic Review and Meta-Analysis

Background: Intussusception (ISN) post-COVID-19 infection in children is rare but can occur. SARS-CoV-2 may play a role in the pathogenesis of ISN and trigger immune activation and mesenteric adenitis, which predispose peristaltic activity to “telescope” a proximal bowel segment into the distal bowel lumen. Objectives: To estimate the prevalence of SARS-CoV-2 infection in ISN children and analyze the demographic parameters, clinical characteristics and treatment outcomes in ISN pediatric patients with COVID-19 illness. Methods: We performed this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies reporting on the incidence of ISN post-SARS-CoV-2 infection in children, published from 1 December 2019 until 1 October 2022, in PROQUEST, MEDLINE, EMBASE, PUBMED, CINAHL, WILEY ONLINE LIBRARY, SCOPUS and NATURE, with a restriction to articles available in the English language, were included. Results: Of the 169 papers that were identified, 34 articles were included in the systematic review and meta-analysis (28 case report, 5 cohort and 1 case-series studies). Studies involving 64 ISN patients with confirmed COVID-19 (all patients were children) were analyzed. The overall pooled proportions of the ISN patients who had PCR-confirmed SARS-CoV-2 infection was 0.06% (95% CI 0.03 to 0.09, n = 1790, four studies, I2 0%, p = 0.64), while 0.07% (95% CI 0.03 to 0.12, n = 1552, three studies, I2 0%, p = 0.47) had success to ISN pneumatic, hydrostatic and surgical reduction treatment and 0.04% (95% CI 0.00 to 0.09, n = 923, two studies, I2 0%, p = 0.97) had failure to ISN pneumatic, hydrostatic and surgical reduction treatment. The median patient age ranged from 1 to 132 months across studies, and most of the patients were in the 1−12 month age group (n = 32, 50%), p = 0.001. The majority of the patients were male (n = 41, 64.1%, p = 0.000) and belonged to White (Caucasian) (n = 25, 39.1%), Hispanic (n = 13, 20.3%) and Asian (n = 5, 7.8%) ethnicity, p = 0.000. The reported ISN classifications by location were mostly ileocolic (n = 35, 54.7%), and few children experienced ileo-ileal ISN (n = 4, 6.2%), p = 0.001. The most common symptoms from ISN were vomiting (n = 36, 56.2%), abdominal pain (n = 29, 45.3%), red currant jelly stools (n = 25, 39.1%) and blood in stool (n = 15, 23.4%). Half of the patients never had any medical comorbidities (n = 32, 50%), p = 0.036. The approaches and treatments commonly used to manage ISN included surgical reduction of the ISN (n = 17, 26.6%), pneumatic reduction of the ISN (n = 13, 20.2%), antibiotics (n = 12, 18.7%), hydrostatic reduction of the ISN (n = 11, 17.2%), laparotomy (n = 10, 15.6%), intravenous fluids (n = 8, 12.5%) and surgical resection (n = 5, 7.8%), p = 0.051. ISN was recurrent in two cases only (n = 2, 3.1%). The patients experienced failure to pneumatic (n = 7, 10.9%), hydrostatic (n = 6, 9.4%) and surgical (n = 1, 1.5%) ISN treatment, p = 0.002. The odds ratios of death were significantly higher in patients with a female gender (OR 1.13, 95% CI 0.31−0.79, p = 0.045), Asian ethnicity (OR 0.38, 95% CI 0.28−0.48, p < 0.001), failure to pneumatic or surgical ISN reduction treatment (OR 0.11, 95% CI 0.05−0.21, p = 0.036), admission to ICU (OR 0.71, 95% CI 0.83−1.18, p = 0.03), intubation and placement of mechanical ventilation (OR 0.68, 95% CI 0.51−1.41, p = 0.01) or suffering from ARDS (OR 0.88, 95% CI 0.93−1.88, p = 0.01) compared to those who survived. Conclusion: Children with SARS-CoV-2 infection are at low risk to develop ISN. A female gender, Asian ethnicity, failure to ISN reduction treatment (pneumatic or surgical), admission to ICU, mechanical ventilation and suffering from ARDS were significantly associated with death following ISN in pediatric COVID-19 patients.

COVID-19-Related Intussusception: A Case Series and Review of the Literature

Background: Ileocolic intussusception is a common gastrointestinal emergency that occurs in infancy. Many cases are caused by anatomic lead points, such as hypertrophied Peyer's patches. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), commonly presents with respiratory symptoms, however, its relation to intussusception remains unknown. Methods: Two cases are reported as well as a review of pertinent English-language literature on the topic. Results: We present two cases of intussusception in COVID-19-positive patients, including the first known case of a lead point with tissue polymerase chain reaction (PCR) confirming COVID-19 positivity, and compare these findings to a review of the recent literature. Intussusception in COVID-19-positive patients is becoming more prevalent and more often requires operative treatment. Discussion: We offer evidence that intussusception can be the presenting symptom in the absence of COVID-19-related respiratory symptoms. There also seems to be a trend toward the need for operative intervention compared with COVID-19-negative intussusception. The presence of SARS-CoV-2 can be confirmed via PCR in specific lead points (lymph nodes), directly causing the intussusception. Conclusions: Providers should have a low threshold to suspect and diagnose intussusception as operative treatment is more readily used in COVID-19-positive pediatric patients with gastrointestinal symptoms.

Findings of Abdominal Imaging in Patients with COVID-19 - Part 1: Hollow Organs

Since COVID-19 has spread worldwide, the role of imaging for early detection of the disease has become more prominent. Abdominal symptoms in COVID-19 are common in addition to respiratory manifestations. This review collected the available data about abdominal computed tomography (CT) and ultrasonography indications in hollow abdominal organs in patients with COVID-19 and their findings. Since abdominal imaging is less frequently used in COVID-19, there is limited information about the gastrointestinal findings. The most common indications for abdominal CT in patients with COVID-19 were abdominal pain and sepsis. Bowel wall thickening and fluid-filled colon were the most common findings in abdominal imaging. Acute mesenteric ischemia (AMI) was one of the COVID-19 presentations secondary to coagulation dysfunction. AMI manifests with sudden abdominal pain associated with high morbidity and mortality in admitted patients; therefore, CT angiography should be considered for early diagnosis of AMI. Ultrasonography is a practical modality because of its availability, safety, rapidity, and ability to be used at the bedside. Clinicians and radiologists should be alert to indications and findings of abdominal imaging modalities in COVID-19 to diagnose the disease and its potentially serious complications promptly.

Is Intussusception in an Adult with Active COVID-19 Infection a Surprise?

The severe acute respiratory syndrome coronavirus 2 (SARS COV2) had rapidly spread and caused a global pandemic worldwide. The most common symptoms in adults are respiratory with dry cough, dyspnea, and fever. Occasionally, extra-respiratory presentations may be seen such as gastrointestinal involvement with diarrhea, vomiting or abdominal pain. Acute intestinal intussusception is the most common cause of bowel obstruction in infants (2–4 months of age) but rarely could it be encountered in adult. It is a very rare gastro-intestinal manifestation of COVID-19 with an invagination of a segment of the bowel within a more distal one. The part that prolapses into the other is called the intussusceptum, and the part that receives it is called the intussuscipiens. Most of COVID-19 cases of AII are reported in the pediatric population between 4 and 10 months. Only a single case of small bowel obstruction secondary to ileo-colic intussusception in a COVID-19 infection adult was published on April 2021. We present here a challenging case of intussusception secondary to COVID-19 infection in an adult in the absence of respiratory symptoms. Our study presents the first case in Africa of AII in adult patients due to COVID-19.

Spontaneous resolution of intussusception after COVID-19 infection found at laparoscopy in a 6-year-old

The incidence of intussusception is 2.5 per 1000 live births, and infants between 4 and 10 months of age represent the highest frequency peak. Cases of intussusception with acute COVID-19 infection have been reported in infants under one year of age and with one death associated with MIS-C. However, we have not found reports of intussusception in schoolchildren. We report the case of a 6-year-old male with two days of illness that began with a sensation of temperature rise, headache, abdominal pain, liquid stools with mucus and no blood, hyporexia, chills, and food vomiting. He presented a negative result for the detection of SARS-CoV-2 antigen, negative SARS-CoV-2 IgM/IgG serology positive (lateral flow immunochromatography test), in addition to total IgM/IgG antibodies in 11.88 COI by means of a test of electrochemiluminescence. An abdominal ultrasound was performed that concluded invagination, for which an exploratory laparoscopy was performed and the patient evolved favorably. 13 cases of intussusception associated with acute COVID-19 infection have been described in this group. However, no reports of intussusception have been described after COVID-19 infection in school age. We recommend ruling out active or past SARS-CoV-2 infection in children with gastrointestinal symptoms and, if it exists, ruling out invagination by means of abdominal ultrasound.

Pediatric Intussusception Following COVID-19 Infection: A Rare Presentation

Pediatric intussusception has been reported to be associated with coronavirus disease 2019 (COVID-19) infection in the literature since the start of the pandemic in the past two years. Although this occurrence is exceptionally rare, rapid diagnosis based on recognition of gastrointestinal manifestations, clinical examination, and ultrasound confirmation can expedite appropriate care and prevent delayed complications. Intussusception is the most common cause of intestinal obstruction and acute abdomen in pediatric patients. Without prompt identification, the disease process can lead to necrosis, bowel perforation, shock, and, subsequently, multiorgan failure. Intussusception has previously been associated with viral upper respiratory infections, which can cause mesenteric lymphadenopathy as a lead point to allow the bowel to telescope upon itself. The mechanism of how COVID-19 can contribute to intussusception without respiratory symptoms remains unknown. Here, we present a case of pediatric intussusception associated with COVID-19.

Intussusception in the setting of severe acute respiratory syndrome coronavirus 2 infection following rotavirus vaccination

Most cases of intussusception are thought to be idiopathic, related to viral infections, structural abnormalities, or certain vaccinations. In this report, we present the development of intussusception in a pediatric patient who was coronavirus 2019 (COVID‐19) positive. Although the most common gastrointestinal symptoms of COVID‐19 virus are diarrhea and vomiting, there recently have been rare case reports of intussusception in patients throughout the world who are severe acute respiratory syndrome coronavirus 2 positive. This case is only the second known report in the United States and the second case reported globally that required surgical intervention for definitive management.

Ileocolic intussusception in pediatric SARS-CoV-2 patients: experience at a tertiary pediatric center

PURPOSE

COVID-19 disease can manifest with intussusception in pediatric patients, but prevalence of abnormalities on ultrasounds performed for intussusception is uncertain. We aim to report our experience in children with COVID-19 presenting with suspected intussusception imaged with ultrasound.

METHODS

Children under 18 years who had an ultrasound for possible intussusception underwent retrospective analysis and were tested for COVID-19 between April 1 and December 14, 2020. Patients' demographic, clinical, radiological and surgical characteristics were reviewed.

RESULTS

Twenty-four COVID-19-positive patients were identified; 19 boys with mean age 3 years (range: 3 months-18 years). Ultrasound was abnormal in 11 patients (11/24, 46%). Sonographic features of enterocolitis were documented in seven children (7/24, 29%). Three boys (3/24, 13%) were found to have ileocolic intussusception on ultrasound and underwent air enema with failed reduction (3/3, 100%), precipitating surgical reductions, all with favorable outcomes. One patient (1/24, 4%) was found to have a long segment of persistent small bowel-small bowel intussusception which was surgically repaired.

CONCLUSION

Given the known association between failed reduction at air enema and delayed presentation, heightened awareness for intussusception in the setting of COVID-19 should be maintained, though more often, the etiology was attributed to other GI manifestations of COVID-19.

Impact of the COVID-19 Pandemic on Emergency Care Utilization and Outcomes in Pediatric Patients with Intussusception

Background: We determined whether a decrease in healthcare utilization patterns during the COVID-19 pandemic affected the treatment process of pediatric patients with intussusception. Methods: Patients with suspected intussusception who had ICD-10 code K561 as their discharge diagnosis from the national database were selected, and those who underwent either radiologic and/or surgical reduction were defined as true intussusception patients. We compared the time periods from patients visiting the ED to ultrasound, radiologic reduction and/or surgical reduction between the study group (first half of 2020, COVID-19 period) and the control groups (control group 1: first half of 2019, control group 2: second half of 2019). Results: The number of suspected intussusception patients in each group was 1223, 1576, and 624, and the incidence rates were 7.85, 11.30, and 4.19 per 100,000 person-half-years (control group 1, control group 2, study group, respectively, p < 0.05). No differences in terms of the time from the ED visit to ultrasound, radiological reduction and/or surgical reduction were noted between the study group and the control groups. Conclusions: In Korea, the COVID-19 pandemic did not significantly affect the ED treatment process or the results of patients with intussusception.

Severe acute respiratory syndrome coronavirus 2 pandemic related morbidity and mortality in patients with pediatric surgical diseases: A concerning challenge

The global spread of the novel severe acute respiratory syndrome coronavirus 2 has had serious consequences in terms of patient morbidity and mortality and overburdened health care systems as well as the socioeconomic implications. In the absence of effective therapies and vaccinations during the viral outbreak, the major and most concise means to control viral spread is spread prevention. Although information concerning the impact of severe acute respiratory syndrome coronavirus 2 on pediatric surgical patients has greatly expanded, relevant comprehensive studies are scarce. However, pandemic related morbidity has increased, while under normal circumstances mortality could have been minimized.

OUP accepted manuscript

Coronavirus disease 2019 (COVID-19) was thought to have respiratory symptoms as the main manifestation, but it has become clear that extrapulmonary symptoms such as gastrointestinal disorders also occur. There are several reports of intussusception associated with COVID-19 in children, but these are rare in adults. In this report, we present a case of cystic intestinal duplication that enlarged during the course of COVID-19 treatment and resulted in intussusception. Right hemicolectomy was performed for intussusception due to the cystic lesion. To the best of our knowledge, this is the first resected case of intussusception due to alimentary tract duplication after COVID-19 infection.

The impact of social distancing during the COVID-19 pandemic on rates of pediatric idiopathic intussusception

BACKGROUND

The causes of idiopathic ileocolic intussusception are unknown, with infection as the most likely culprit. Recently, social distancing measures were implemented during the coronavirus disease 2019 (COVID-19) pandemic to decrease transmissible infectious diseases, creating an opportune setting to study the role of infection on the pathogenesis of intussusception on a population level.

OBJECTIVE

To investigate the impact of social distancing on intussusception.

MATERIALS AND METHODS

We retrospectively reviewed air contrast enemas and pylorus ultrasounds performed between March 2010 and March 2021 to identify cases of ileocolic intussusception and hypertrophic pyloric stenosis (HPS), using the latter as a negative control. The study time frame was divided into two periods: pre-pandemic (March 2010-February 2020) and pandemic (April 2020-March 2021). The number of cases that occurred in these two time periods were compared using the Poisson regression model.

RESULTS

Of the 407 cases of idiopathic ileocolic intussusception identified, 396 occurred in the pre-pandemic time period (mean = 39.6 per 12-month period) and 11 occurred in the 12-month pandemic time period. The mean monthly number of intussusceptions showed a decline of 72% (95% confidence interval [CI] 49-85%) between the pre-pandemic and pandemic time periods (3.3 vs. 0.9 monthly cases; P < 0.001). In contrast, the mean monthly number of HPS did not differ significantly (P = 0.19).

CONCLUSION

Social distancing-imposed to curb the spread of infection during the COVID-19 pandemic-resulted in a significant decline in ileocolic intussusception, lending strong support to the theory that infection is the dominant cause of intussusception.

A lethargic child with COVID-19 infection

ABSTRACT

COVID-19 infection in children is less understood than COVID-19 infection in adults, and although it is believed to cause mild or asymptomatic infections, several cases of severe or atypical presentations have been reported. Children presenting with gastrointestinal symptoms, even those without respiratory symptoms, should raise the suspicion for possible COVID-19 infection. This case report describes a 20-month-old girl with a clear history of COVID-19 exposure whose acute abdomen and lethargy were diagnosed as COVID-19 infection complicated by intussusception.

Abdominal pain in children with COVID-19

OBJECTIVE

To analyze clinical features, diagnosis and treatment of pediatric patients referred to our pediatric surgery center with abdominal pain as a main manifestation of COVID-19.

MATERIAL AND METHODS

We retrospectively reviewed 56 patients with abdominal pain associated with SARS-CoV-2 infection at the Basrah Children Specialty Hospital between June 2020 and December 2021. We collected data including demographic data, symptoms, imaging data, laboratory findings, treatments, and clinical outcomes.

RESULTS

Fifty-six patients (48 male and 8 female) with a median age of 9 years were analyzed. All patients had abdominal pain. Fifty-two patients complained of vomiting, 48 patients with fever, 36 patients with cough, and 20 patients with shortness of breath. Twenty patients were diagnosed with acute appendicitis, two of them had appendicular abscess. Mesenteric lymphadenitis was found in 12 patients, obstructed inguinal hernia in 4 patients, and epididymo-orchitis in two patients. Ten patients required surgical intervention.

CONCLUSION

COVID-19 should be suspected in any child presenting with acute abdominal pain. In the era of COVID-19, all cases of abdominal pain in children including those with acute appendicitis are better to be treated conservatively.

Decreased Incidence of Pediatric Intussusception during COVID-19

Coronavirus disease 2019 (COVID-19) changed the epidemiology of various diseases. The present study retrospectively investigates the epidemiologic and clinical changes in pediatric intussusception for ages ≤ 7 years before (February 2019–January 2020) and after (February 2020–January 2021) the COVID-19 outbreak in a single pediatric emergency department of a university-affiliated tertiary hospital. The incidence of communicable diseases—defined as infectious diseases with the potential for human-to-human transmission via all methods, non-communicable diseases, and intussusception were decreased following the COVID-19 outbreak (15,932 to 3880 (24.4%), 12,994 to 8050 (62.0%), and 87 to 27 (31.0%), respectively). The incidence of intussusception correlated significantly with the change in incidence of communicable diseases (Poisson log-linear regression, odds ratio = 2.15, 95% CI = 1.08–4.26, and p = 0.029). Compared with the pre-pandemic period, patients of the pandemic period showed higher proportions of pathologic leading point (PLP) and hospitalization (14.8% vs. 2.3% and 18.5% vs. 4.6%, respectively), lower base excesses (−4.8 mmol/L vs. −3.6 mmol/L), and higher lactate concentrations (1.7 mmol/L vs. 1.5 mmol/L). The incidence of pediatric intussusception decreased after the COVID-19 pandemic. This reduced incidence may be related to the reduced incidence of communicable diseases. However, the proportions of more severe diseases and PLPs were higher after the COVID-19 pandemic.

The impact of the COVID-19 pandemic on child health

Most Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections in children are mild or asymptomatic. Severe Coronavirus Disease 2019 (COVID-19) in children is infrequent. An estimated 0.3–1.3% of children with SARS-CoV-2 infection were admitted to hospital, and of these 13–23% needed critical care. SARS-CoV-2 related deaths were very rare in children, estimated at 2 per million. The vast majority of admitted children had one of shortness of breath, fever, and cough, but atypical symptoms are more common in children. Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) have been linked to SARS-CoV-2 infection. Cardinal symptoms include prolonged fever, clinical signs of inflammation, gastro-intestinal symptoms, and cardiac dysfunction. Twenty two to 80% of patients with MIS-C needed critical care; mortality of MIS-C is around 2%. Six to 24% of children with MIS-C had coronary artery dilatation or cardiac aneurysms. Equipoise still exists between first-line treatment with immunoglobulins and steroids. Outcomes for children with MIS-C are generally very good in those recognised early and started on appropriate treatment. Vaccination schemes for children are rapidly expanding, with the benefits of preventing severe COVID-19 disease and MIS-C and reducing community transmission outweighing the risks of adverse events of, amongst others, myocarditis temporally related to COVID-19 vaccination in children and young adults. The imposed social distancing measures reduced the overall number of children with acute illness or injury presenting to urgent and emergency care facilities worldwide. No clear signal was seen that large numbers of children had a delayed presentation to emergency care departments with a serious illness. The social distancing measures negatively impacted the mental health of children.

Pediatric Covid-19 mesenteric lymphoid hyperplasia associated intussusception: A case report and literature review

A 2 month old, full term, previously healthy male, with known COVID-19 infection 3 weeks prior to arrival presented to the Emergency Department (ED) with complaints of 5–6 episodes of non-bilious and non-bloody emesis. According to the child's parents, the emesis was mostly associated with feeding. His parents endorsed that the patient had one episode of diarrhea that was maroon in color and appeared different than typical stools. Abdominal exam at that time was non distended with no tenderness and no other significant findings. The patient was observed while feeding in the ED and was noted to have some minimal spit up with arching of his back. A presumptive diagnosis of reflux was made, and the patient was discharged home with education on feeding.

The infant was brought back to the ED the following day due to worsening emesis. Additionally, his parents noted more episodes of bloody stools. His abdomen appeared mildly distended with moderate tenderness on abdominal examination. During evaluation, a large “currant jelly” stool was observed (Fig. 1). An abdominal ultrasound was obtained, which demonstrated an ileocolic intussusception with a possible enlarged lymph node as lead point. The patient received an air contrast enema with successful reduction. Repeat ultrasound was obtained which confirmed resolution, and the patient was admitted for overnight observation. The patient tested positive for SARS-CoV-2 using polymerase chain reaction testing. He was discharged the following day after successful advancing of diet, normal serial abdominal exams, and observed normal bowel movements.

A Systematic Review of Abdominal Imaging Findings in COVID-19 Patients

OBJECTIVE

The objective of this systematic review was to evaluate key imaging manifestations of COVID-19 on abdominal imaging by utilizing a comprehensive review of the published literature.

METHOD

A systematic literature search from PubMed, Google Scholar, and Scopus was performed for studies mentioning abdominal imaging findings in COVID-19 patients. Studies published from inception to 15 March 2021 were included.

RESULTS

A total of 116 studies comprising 1,198 patients were included. Abdominal pain was the most common indication for abdominal imaging in 50.2% of the patients. No abnormality was seen in 48.1% of abdominopelvic computed tomography scans. Segmental bowel wall thickening (14.7%) was the most common imaging abnormality, followed by bowel ischemia (7.1%), solid organ infarction (6.7%), vessel thrombosis (6.7%), and fluid-filled colon (6.2%). Other relevant findings were dilated air-filled bowel, pancreatitis, pneumatosis/portal venous gas, bowel perforation, and appendicitis. Other than abdominal findings, COVID-19-related basal lung changes were incidentally detected in many studies. Moreover, the presence of bowel imaging findings was positively correlated with the clinical severity of COVID-19 infection.

CONCLUSION

This review describes the abdominal imaging findings in COVID-19 patients. This is pertinent for the early diagnosis of COVID-19 in patients presenting solely with abdominal symptoms as well as in identifying abdominal complications in a known case of COVID-19.

Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature

BACKGROUND

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 via 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.

AIM

To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies.

METHODS

Bibliographical searches were performed in PubMed, using the following keywords: “COVID-19” AND “imaging” AND “gastrointestinal” OR “abdominal” OR “small bowel”.

RESULTS

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.

CONCLUSION

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.

Right hemicolectomy for ileocolonic intussusception in an adult with active COVID-19 infection: a case report

The most common symptoms of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) are fevers, fatigue and dry cough. However, growing data suggest gastrointestinal (GI) manifestations occur in the majority of patients. Small bowel obstruction remains a significant cause of surgical abdominal emergencies in the adult population, although most cases are secondary to adhesive disease. We present a case of ileocolonic intussusception in an adult with active COVID-19 infection. Our patient presented with small bowel obstruction 4 days after diagnosis of COVID-19 with typical respiratory symptoms. Imaging revealed ileocolonic intussusception and possible cecal mass for which a right hemicolectomy was performed. Recovery was unremarkable. Pathology suggested necrosis without an identifiable mass. To the best of our knowledge, this is the first documented case of small bowel obstruction secondary to ileocolonic intussusception in an adult related to GI manifestation of COVID-19.

Intussusception and COVID19, Successful Mechanic Reduction, Case Report

The COVID 19 pandemic has greatly affected the world population. SARS CoV2 infection in pediatric patients is related to the development of mild symptoms and in some cases gastrointestinal manifestations. We present the case of a patient with intussusception as a manifestation associated with SARS CoV2 infection, treated by ultrasound-guided hydrostatic reduction with successful results.

COVID-19 presenting as intussusception in infants: A case report with literature review

The novel Corona virus disease 2019 (COVID-19) first presented in Wuhan, China. The virus was able to spread throughout the world, causing a global health crisis. The virus spread widely in Jordan after a wedding party held in northern Jordan. In most cases of COVID-19 infection, respiratory symptoms are predominant. However, in rare cases the disease may present with non-respiratory symptoms. The presentation of COVID-19 as a case of intussusception in children is a strange and rare phenomenon. We present here a case of a two-and-a-half month old male baby who was brought to hospital due to fever, frequent vomiting, dehydration and blood in stool. He was diagnosed as intussusception. The child was tested for corona due to the large societal spread of the virus and because he was near his mother, who was suffering from symptoms similar to corona or seasonal flu (she did not conduct a corona test). Patient was treated without surgery and recovered quickly. The COVID-19 infection was without respiratory symptoms, and there was no need for the child to remain in hospital after treatment of intussusception. The relationship between viruses, mesenteric lymphoid hyperplasia, and intussusception is a confirmed relation. ACE2 is the key receptor required for SARA-COV-2 to enter the host cells. ACE2 has been also found in the brush border of the intestinal mucosa, as well as it is a key inflammatory regulator in the intestine. This may suggest that SARSA-COV-2 could invade the respiratory tract as well as gastrointestinal tract or both. Few case reports documented the presentation of COVID-19 as intussusception in children. In the light of the wide-spread of corona virus, performing COVID-19 tests for children with intussusception can help linking the two entities. Development of gastrointestinal symptoms in COVID-19 positive children should raise concern about the development of intussusception.

Intussusception and SARS-CoV-2 infection

We present 2 cases in the same city, of coexistence of intussusception and SARS-CoV-2 infection. The first in an 8 month old male in August 2020 and the second in a 7 month old female in October 2020; both resolved by surgical technique. Although it is known that some intussusception cases. can present concomitantly with viral infections, the fact that they appear in the same context as COVID-19 has only been reported as of late; these 2 new cases are added to the 6 reported so far. In the future, it will be analyzed whether this coexistence is the result of an association between the 2 diseases.

Intussusception in an Infant With SARS-CoV-2 Infection: A Case Report and a Review of the Literature

Coronavirus disease 2019 (COVID-19) is caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Even if predominantly considered a respiratory pathogen, it could be associated with gastrointestinal involvement, generally in mild forms. Recent reports highlight the association between SARS-CoV-2 and intussusception in infants. A case of intussusception is hereby described in a previously healthy infant in whom the diagnosis of SARS-CoV-2 was made after the analysis of bronchoalveolar lavage and intraoperative specimens following surgical procedures. Accordingly, a review of infant cases with intussusception and SARS-CoV-2 infection is also reported.