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Updated: Nov 25, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Ischemic gastrointestinal complications of COVID-19: a systematic review on imaging presentation
Pedram Keshavarz1, Faranak Rafiee2, Hadiseh Kavandi3
1Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia.
Insights
Gastrointestinal ischemia in COVID-19 patients is often linked to blood clots, particularly in the mesenteric arteries and veins. This serious complication led to high rates of surgery and a significant mortality rate of nearly 40% in reviewed cases.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Infectious Diseases
Background:
- Limited data exists on gastrointestinal (GI) ischemia in coronavirus disease 2019 (COVID-19) patients.
- This study reviews clinical and radiologic features of GI ischemia in COVID-19.
Purpose of the Study:
- To analyze the clinical and radiologic characteristics of GI ischemia in COVID-19 patients.
- To understand the complications and outcomes associated with GI ischemia in the context of COVID-19.
Main Methods:
- Systematic literature review of studies published from January 2020 to September 2020.
- Inclusion criteria: studies with COVID-19-related GI ischemia complications and imaging findings.
- Databases searched: PubMed, Scopus, Embase, Web of Science, Google Scholar.
Main Results:
- Thirty-one patients from twenty-two studies were analyzed (mean age 59).
- Mesenteric arterial or venous thromboembolism was a significant finding, leading to small bowel ischemia in 29% of cases.
- 64.5% of patients required laparotomy and bowel resection; mortality was 38.7%.
Conclusions:
- Macrovascular thrombosis is common in COVID-19 patients with bowel ischemia.
- Radiologically evident mesenteric thrombotic occlusion is associated with a high mortality rate (approximately 40%).
Background:
Limited data is available addressing gastrointestinal (GI) ischemia in coronavirus disease 2019 (COVID-19). We reviewed the clinical and radiologic features of GI ischemia and its related complications in thirty-one COVID-19 patients reported in literature.
Methods:
A systematic literature review was performed using a search strategy on all studies published from January 1, 2020, to June 13, 2020, and updated on September 6, 2020, on databases from PubMed, Scopus, Embase, Web of Science, and Google Scholar. Every study with at least one presentation of COVID-19-related GI ischemia complication and one GI imaging finding was included.
Results:
In total, twenty-two studies and thirty-one patients with the mean age of 59 ± 12.7 (age range: 28-80) years old were included, of which 23 (74.2%) patients were male, 7 (22.5%) female, and one unknown gender. The significant GI imaging findings include mesenteric arterial or venous thromboembolism, followed by small bowel ischemia. Nine patients (29%) presented with arterial compromise due to superior mesenteric thromboembolism, resulting in bowel ischemia. Also, 6 patients (19.3%) demonstrated occlusive thrombosis of the portal system and superior mesenteric vein. More than two-thirds of patients (20, 64.5%) required laparotomy and bowel resection. Eventually, five (16.1%) patients were discharged, of whom four cases (12.9%) readmitted. Five (16.1%) patients remained ICU hospitalized at the report time and 12 (38.7%) patients died.
Conclusion:
Macrovascular arterial/venous thrombosis is identified in almost half of COVID-19 patients with bowel ischemia. Overall mortality in COVID-19 patients with GI ischemia and radiologically evident mesenteric thrombotic occlusion was 38.7% and 40%, retrospectively.
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