Clinical Course and Management of Kawasaki Disease Complicated with Duodenal Bleeding: A Two-Stage Case Review and Literature Analysis

Objective: To explore the clinical characteristics, diagnostic process, treatment measures, and prognosis of Kawasaki disease (KD) combined with duodenal bleeding and to improve the understanding of this rare but serious complication. Methods: We analyzed retrospectively the comprehensive clinical data of a child diagnosed with KD who was admitted to our hospital with duodenal bleeding. In addition to this case, three similar instances identified through a literature review were included. We summarized and compared the clinical manifestations, laboratory tests, imaging and endoscopic findings, treatment strategies, and prognoses. Results: All four children were male, aged 2.5-11 years old, and the types of KD included typical, atypical, and Kawasaki disease shock syndrome(KDSS). All clinical manifestations of KD, such as fever, rash, and conjunctival congestion, followed by gastrointestinal bleeding, such as melena, hematemesis, or hemorrhagic shock. Gastroscopy confirmed that duodenal bulb ulcer or perforation was the source of bleeding. Some children had intravenous immunoglobulin (IVIG) non-response or severe cardiovascular complications (such as coronary artery aneurysm). Treatment is mainly IVIG, antiplatelet or anticoagulant drugs, proton pump inhibitors, endoscopic hemostasis, or surgical repair. Most children have a good prognosis, and heart disease does not progress further. Conclusion: Duodenal bleeding is a rare but serious complication of Kawasaki disease that requires vigilance, especially when there is no response to IVIG, KDSS, or severe inflammatory response. Timely gastrointestinal evaluation act,ive hemostasis, and supportive treatment measures can help improve the prognosis.