Bangladesh is a tropical country with vast lands submerged in water, including ponds, canals and swamps. This wetlands harbor leeches, which particularly infest children during bathing, playing or fishing. Leech bite is common in the rural areas of Bangladesh in rainy season (Ashar & Srabon) found in the external body surfaces like nose, pharynx, larynx, esophagus, genitalia, urethra and rectum. Vaginal bleeding in children as the result of a leech bite is very rare and there are only three case reports available in the Medline Indexed literature. In most instances, leeches are detected and removed immediately, but sometimes they find their way through body orifices into one of the lower body cavities and often give rise to serious consequences. Entrance of a leech into the peritoneal cavity through a female genital tract of a young girl is possible especially when bathing, fishing or playing in a pond or a river.
In our case, 10 years-old girl Nipa hailing from Munshibazar Lebukhali, Dumki under Patuakhali district brought to LHCB Hospital with persistent vaginal bleeding. The patient's mother gave the history of vaginal bleeding following fishing in a nearby pond. Her father was a fisherman. It was his illness made the child to replace him because fishing is the only source of living for them otherwise they had to starve. She did not notice the bleeding until she came back to home. When she presented to the hospital her general clinical condition was stable except for tachycardia and mild pallor. There was no history of trauma, pain or evidence of sexual abuse. She had normal growth and development for her age. There was no significant medical or surgical history. There was no hemorrhagic fluid or exudates found in the peritoneal cavity. The sites of the gut where leech was attached were red in appearance and edematous but there was no ulceration or perforation.
Bleeding from a leech bite wound can persist for a mean of 10 hours and as long as 7 days. The prolonged bleeding after a leech bite is due to the action of factors in the leech saliva left in the bite, which include; Histamine-like vasodilator Hirudin (a potent antithrombin) & Hyaluronidase Calin (a platelet aggregation inhibitor). In our case no other port of entry of the leech was found on external or internal surfaces of the abdomen since the leech was automatically detached from the vagina and was found on the floor. But a very young child with intact hymen and in a family who gives high value for virginity creates the diagnostic challenge.
Dr. Swapon Sarker – Medical Officer of LHCB after examine gave pack to stop the bleeding and then drenched the wound with antiseptic solutions. Her complete blood count was done. The postoperative recovery was uneventful and the patient was discharged on the second day on follow up after 2 weeks. Nipa’s family initially became worried since in Bangladesh for a girl to face such incident can create unwelcoming circumstances in her life. But both Nipa and her family praised us for our service and prayed to almighty for our organizational well being.
