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Save the life of a case of severe gastrointestinal bleeding from a stomach ulcer in a child with COVID-19

Recently, City Children’s Hospital received a child Ng. TL, 13 years old, female, lives in Can Tho. Taking the child’s medical history for 5 days, the child had a fever on 1-3 days, sore throat, on the 4th and 5th day, the child had less fever, abdominal pain in the epigastrium, vomiting blood, so they were admitted to a local hospital for first aid and transferred to a Children’s Hospital. City Council. No previous history of abdominal pain or gastric ulcer was noted. Here, the child was lethargic, the skin was pale, the pulse was light and cool, the heart rate was 130 beats/minute, the blood pressure dropped 80/60mmHg, vomiting bright red blood, black stools, urgent Hct test. only 12% (normal Hct 40-45% in this age group), rapid test for SARS-CoV-2 was positive and Real Time RT PCR for SARS-CoV-2 was positive afterwards. The child was diagnosed with severe gastrointestinal bleeding suspected of peptic ulcer disease/COVID-19 and was treated with respiratory support, anti-shock fluids, 1200ml blood transfusion, 300ml fresh frozen plasma, platelet concentrate 6 units, correcting the acid-base disturbances, gastroenterology consultation, surgery, emergency endoscopy to record bleeding ulcers in the cardia, gastric aneurysm should be carried out. Hemostasis of the bleeding site of aneurysmal aneurysms with adrenaline 1/10,000. After hemostasis with adrenaline, observed for 30 minutes, no further bleeding was observed. After that, the child was transferred to the intensive care unit for further treatment, the child was mechanically ventilated, taking antiretroviral drugs, drugs to reduce gastric secretion, antibiotics, and black stools once thought due to the old blood remaining in the digestive tract, Hct improved 34-36%. Results after 1 week of treatment, the child was weaned from the ventilator, awake, did not vomit, could drink milk, had yellow stools, and the Real Time RT PCR SARS-CoV-2 result was negative after 14 days.

  At home, still bitten by snakes

Studies show that SARS-CoV-2 does not only enter respiratory cells through angiotensin-converting enzyme receptor 2 (ACE2), specifically, the spike protein (S) anchored in the viral envelope has a high affinity for ACE2 is human and consists of 2 functional subunits, S1 and S2, that facilitate attachment to host cells and fusion with cell membranes, but also entry into gastrointestinal cells because the ACE2 receptor is expressed not only in respiratory, cardiovascular, liver, kidney, and pancreatic tissues, which are also abundant in the gastrointestinal system including the esophagus, stomach, duodenum, jejunum, ileum, cecum and large intestine, making SARS-CoV-2 can attack the gastrointestinal tract causing hemorrhagic ulcers, as well as cause gastrointestinal homeostasis, especially the intestinal microflora, causing symptoms of vomiting, abdominal pain, flatulence, constipation, gastrointestinal bleeding. Therefore, parents should note that when your child has a fever with vomiting, abdominal pain, diarrhea, etc., please take your child to a medical facility that specializes in pediatrics for examination, accurate diagnosis and appropriate treatment.

Young Ng.  TL, 13 years old, female, severe gastrointestinal bleeding due to peptic ulcer, gastric aneurysm/COVID-19, emergency gastrointestinal endoscopy to stop bleeding
Young Ng. TL, 13 years old, female, severe gastrointestinal bleeding due to peptic ulcer, gastric aneurysm/COVID-19, emergency gastrointestinal endoscopy to stop bleeding
After 2 weeks of treatment, the child recovered, was discharged and was re-examined by appointment in the joy of the mother
After 2 weeks of treatment, the child recovered, was discharged and was re-examined by appointment in the joy of the mother

Doctor of CK2 Nguyen Minh Tien
City Children’s Hospital

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