Intestinal intussusception may be rare gastrointestinal manifestation of COVID-19 in adults: A case study

Intestinal intussusception may be a rare gastro-intestinal manifestation of COVID-19 with an invagination of a segment of the bowel within a more distal one. However timely diagnosis and management can improve the outcomes of patients suffering from Intestinal intussusception in adults, according to the case study published in the Indian Journal of Surgery.

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 adults.

It is a very rare gastrointestinal 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 the 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 ileocolic intussusception in a COVID-19 infection adult was published on April 2021.

The authors Marwa Gargouri et. al presented a challenging case of intussusception secondary to COVID-19 infection in an adult in the absence of respiratory symptoms. Their study presented the first case in Africa of AII in adult patients due to COVID-19.

A 51-year-old man, without a relevant medical history, presented to the emergency department with complaints of episodic abdominal pains and vomiting for 5 days. No histories of respiratory symptoms or blood in the stool were reported.

The patient was conscious, asthenic with a fever of 39 °C and blood pressure of 120/60 mmHg. The pulse was 108 per minute, respiratory rate was 20, and oxygen saturation was 98% on room air. Physical examination revealed a soft abdomen with mild generalized tenderness on palpation. Inflammatory markers were raised C-reactive protein level was 223 mg/l and white cells count level of 17.7 × 103/µl with 65% neutrophils. Renal and liver markers were unremarkable. The diagnosis of AII was confirmed by the abdominal computed tomography scan with intravenous contrast showing dilatation of the small bowel with jujeno-jujenal intussusception.

His nasopharyngeal swab was tested positive for SARS COV2 using a polymerase chain reaction.

The patient was admitted in the COVID-19 unit. After intubation and exploratory laparotomy, necrosis of the small intestine was found, and jejunal resection followed by jejuno-jejunal anastomosis was performed. The anesthesiology team, all surgical and nursing staff wore a single-use N95, a face shield, goggles, a gown, and double gloves. The histological findings were dominated by ischemic necrosis, hemorrhage, edema, and moderate lymphoid hyperplasia. Our patient was treated with vasoactive substances (dopamine) to improve circulation, antibiotics (cefotaxime and metronidazole), a methylprednisolone intravenous drip, and anti-thrombotic treatment.

After full recovery, the patient was discharged on a postoperative day 5 without complications.

"Our case presents that Coronavirus disease 2019 could be implicated in acute intestinal intussusception in adults' patients with non-specific gastro-intestinal symptoms. To date, it has been difficult to establish the association between the Coronavirus and acute intestinal intussusception. Frontline clinicians have to consider Coronavirus infection when dealing with gastrointestinal symptoms. When the pathology is diagnosed early, we have more chances for a successful management of the Coronavirus disease and avoidance of severe complications," the authors conclusively noted.