title: Leech infestation in children through body orifices: experience in a hospital in Bangladesh.
abstract: BACKGROUND
  Bangladesh harbors many leeches in its vast wetlands. Leeches have a tendency to enter through body orifices with potentially life-threatening consequences. Literature search revealed inadequate description of clinical manifestations and treatment of leech infestations in children. We describe our experience with leech infestations in children.
  
  
  METHODS
  Between January 1, 2004 and December 31, 2010, 17 cases of leech infestation through body orifices in children were managed. This is a retrospective study on age, sex, route of leech entry, investigation and treatment, and outcome.
  
  
  RESULTS
  Age ranged from 4.5 to 11 years (mean 6.4 ± 1.8) and females accounted for more than 70 %. The orifices of leech entry include urethra, vagina, and rectum. Leeches could be found in eight cases. Two boys with leeches in the urinary bladder needed suprapubic removal. Leeches were retrieved from the vagina under general anesthesia in three cases, and on three occasions leeches came out from the vagina after normal saline instillation. In nine cases with different routes of entry where leech was not found, instillation of normal saline was sufficient to stop bleeding. Fifteen cases presented with bleeding and transfusion was required in five cases with Hb% <7 gm/dl.
  
  
  CONCLUSIONS
  Leech infestation through lower body orifices is common in children of rural Bangladesh. Prompt diagnosis is of paramount importance, and application of normal saline is effective in most cases. Sometimes surgical intervention is required.
authors.affiliation: Pediatric Surgery, Chattagram Maa-O-Shishu Hospital Medical College, Chittagong, Bangladesh. boto_briksha@yahoo.com
authors.forename: Md Jafrul
authors.initials: MJ
authors.lastname: Hannan
authors.forename: Md Mozammel
authors.initials: MM
authors.lastname: Hoque
mesh_terms: D000818:Animals; D001459:Bangladesh; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007865:Leeches; D008297:Male; D010272:Parasitic Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D012002:Rectal Diseases / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D014521:Urethra; D001745:Urinary Bladder Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016055:Urinary Retention / Q000209:etiology; D014623:Vaginal Diseases / Q000175:diagnosis / Q000628:therapy