Case report leech infestation presenting as metromenorrhagia

ABSTRACT

This case s presented to show that leech infestation is still not uncommon in Iraq especially of the genital tract. Leech infestation, could cause menorrhagia in women. A 45 years old multiparous woman from Sinjar's rural areas in Mosul province, attending the out patient department with severe vaginal bleeding, and a history of moderate, continuous vaginal bleeding for four months. She underwent diagnostic curettage three months before, which revealed normal secretory endometrium. The infected woman was pale and hypotensive with features of chronic iron deficiency anemia. Speculum and gynecological examinations demonstrated no abnormalities. Total abdominal hysterectomy as an emergency was done with preservation of both ovaries; bleeding persisted postoperatively; re-assessment by speculum pelvic examination revealed leech infestation of the vagina. The Leech belongs to Phyllum Annelida, class Hirudinea, and order Rhychobdellida. An infestation with leeches should be considered in patients who present with menorrhagia and history of immersion in fresh water lakes or streams in tropical infested areas. Leech infestation is not common in gynecological practice, and is rare nowadays as water supplied to all cities and villages is passing through filtration and disinfection process. Leech infestation should be remembered, as a cause of menorrhagea, in areas where using river water and sitting at riverside is habitual for women in infested rural areas