Leech in the Rectum Causing Lower GI Bleeding in a Four Years Old Child: A Case Report

Abstract

BACKGROUND፡ Leeches belong to a group of annelids of the class Hirudinea which are blood feeding ecto-parasites of humans, wild animals and domesticated animals. A leech can suck out as much blood as ten times its own weight. Leech can occur at different sites in humans commonly in the eyes, nasopharynx, larynx, urethra, and vagina and rarely in the rectum.CASE DETAILS: This is a four years old male child who presented with painless, bright red rectal bleeding for two weeks. Heamatocrit was 9.2%. Leech was removed from the rectum by letting the child sit on a bucket of water. The patient was transfused, followed for 24 hours and discharged with iron sulphate syrup.CONCLUSION: Leech infestation should be considered in the differential diagnosis of a child presenting with hematochezia.

Manifestation of leech infestation as severe gastrointestinal bleeding in a 3-year-old boy: a case report and review of the literature

“…For the most part, leeches’ main target is nasopharyngeal area [ 11 ]. But in some cases, it was reported to affect the rectum or esophagus [ 6 , 10 ]. Due to the variety of leech infestation sites, this disease manifests itself with different symptoms such as epistaxis [ 8 ], hematemesis [ 7 , 12 ], melena, rectal bleeding [ 6 ], and even cough [ 7 ].…”

“…But in some cases, it was reported to affect the rectum or esophagus [ 6 , 10 ]. Due to the variety of leech infestation sites, this disease manifests itself with different symptoms such as epistaxis [ 8 ], hematemesis [ 7 , 12 ], melena, rectal bleeding [ 6 ], and even cough [ 7 ]. For a comprehensive review of this topic, we conducted an advanced search of the PubMed/Medline, Scopus, and Web of Science databases using keywords and Mesh terms (“leeches” [Mesh], leech, hirudinea, “gastrointestinal Hemorrhage”[Mesh], hematochezia, hematemesis, melena), which are presented in Table 1 .…”

“…According to the collected studies, the majority of them occurred in children [ 5 – 8 , 14 – 17 , 19 , 20 , 22 ], which can highlight the role of parents in monitoring their children’s high-risk behaviors because the child does not understand the difference between healthy and non-drinking water. On the other hand, we surveyed the study countries and found that almost all were in low- or lower-middle-income countries with less access to clean water and less public health information [ 6 , 13 , 14 , 16 , 20 , 22 ]. Finally, the source of this unhealthy water is usually reported springs, natural lakes, and rivers [ 5 , 6 , 12 , 16 , 19 , 22 ], which are primarily located in rural areas and far from cities, and in some reports, just swimming in such waters and not even drinking from them can increase the probabilities of catching leech infestation.…”

“…Furthermore, they have some anticoagulant-like enzymes in their saliva that can lead to severe bleeding after infestation, which in complicated cases can also lead to the patient’s death [ 3 , 4 ]. They can involve various parts of the GI tract and the respiratory system, including the nasopharynx, oral cavity, larynx, esophagus, and rectum [ 5 , 6 ]. GI bleeding, which is caused by leech infestation, can manifest itself in different patterns, such as epistaxis, hematemesis [ 7 ], melena [ 8 ], and fresh rectal bleeding [ 9 ].…”

Upper GI Bleeding Due to Leech Infestation in Ethiopian Patients: A Case Series and Review of Literature

“…17 The soft and slippery body surfaces of aquatic leeches combined with strong attachment of the suckers to the mucosal surface, render a challenge in the removal of the parasite, as it is more likely to rupture. 18 Thus, several techniques have been suggested. Forceps application to the center of the leech's body and giving a quick pull is one such method that is successful in several cases.…”