Severe Upper Gastrointestinal Bleeding in a 12-Year-Old Boy with Acute SARS-CoV-2 Infection Complicating Perforated Appendicitis: A Case Report and Differential Considerations
Gastroenterology Insights·
- DOI
- 10.3390/gastroent17030047
- PMID
- —
- PMCID
- —
- OpenAlex
- —
- Study type
- Journal article
- Publisher
- MDPI AG
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The authors note severe upper GI bleeding is rare in children with SARS-CoV-2 infection and MIS-C, and that bleeding occurred despite continuous PPI prophylaxis, suggesting consideration of risk-factor-based prophylaxis and monitoring of vitamin K-dependent coagulation in critically ill children on high-dose corticosteroids and prolonged broad-spectrum antibiotics.
Structured evidence summary
Research question
The report describes a clinical presentation of severe upper gastrointestinal bleeding in a paediatric patient with acute SARS-CoV-2 infection and features overlapping with MIS-C, alongside differential considerations.
Study design
Single-patient case report describing clinical presentation, management, and recovery, including a brief discussion of possible mechanisms.
Population and setting
A previously healthy 12-year-old boy hospitalised after appendectomy for perforated appendicitis with peritonitis, who developed fever and SARS-CoV-2 positivity on postoperative Day 1 and was managed in a paediatric intensive care unit.
Main findings
Severe upper GI bleeding occurred on PICU Day 4, with coagulopathy (prolonged INR, reduced prothrombin activity) and diffuse mucosal bleeding without ulcers on endoscopy. Recovery followed supportive transfusion, vitamin K, and ongoing care, with discharge after 20 days showing mild residual anaemia and elevated inflammatory/coagulation markers.
Public-health relevance
The authors note severe upper GI bleeding is rare in children with SARS-CoV-2 infection and MIS-C, and that bleeding occurred despite continuous PPI prophylaxis, suggesting consideration of risk-factor-based prophylaxis and monitoring of vitamin K-dependent coagulation in critically ill children on high-dose corticosteroids and prolonged broad-spectrum antibiotics.
Important limitations
The authors explicitly state that the relative contributions of proposed mechanisms cannot be determined from a single retrospective case and that MIS-C diagnosis cannot be regarded as secure because perforated appendicitis with peritonitis provides a sufficient alternative explanation.
GIDS interpretation
This single case report contributes descriptive clinical context for rare paediatric GI complications reported during SARS-CoV-2 infection; it does not establish incidence or causality and cannot be linked to a live surveillance signal without the original paper.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 7 auditable classifier relationships to diseases, places, topics, and study design.