title: Vaginal Leech Infestation: A Rare Cause of Hypovolumic Shock In Postmenopausal Woman.
abstract: BACKGROUND
  Human leech infestation is a disease of the poor who live in rural areas and use water contaminated with leeches. Like any other body orifices, vagina can also be infested by leech when females use contaminated water for bathing and/or douching. Although this condition is very rare in postmenopausal women, it causes morbidities and mortalities.
  
  
  METHODS
  A 70 year old Para X (all alive) abortion I mother, postmenopausal for the last 20 years, presented with vaginal bleeding of 3 weeks duration to Gimbie Adventist Hospital, Western Ethiopia. On examination, she had deranged vital signs and there was a dark moving worm attached to the cervical os. She was admitted with the diagnosis of hypovolumic shock and severe anemia secondary to postmenopausal vaginal bleeding. After the patient was stabilized with intravenous crystalloids, the leech was removed from the vagina. She was then transfused with two units of whole blood and discharged with good condition on the 3(rd) post procedure day with ferrous sulphate.
  
  
  CONCLUSIONS
  Vaginal leech infestation in postmenopausal woman can cause hypovolumic shock and severe anemia. Therefore, in order to decrease morbidities from failure or delay in making the diagnosis, health care providers should consider the possibility of vaginal leech infestation in postmenopausal woman from rural areas and those who use river water for drinking, bathing and/or douching and presented with vaginal bleeding. In addition, the importance of using clean water and improving access to safe water should be emphasized.
authors.affiliation: Department of Obstetrics and Gynecology, Wollega University, Nekemte, Ethiopia.
authors.forename: Temesgen
authors.initials: T
authors.lastname: Tilahun
mesh_terms: D000368:Aged; D000740:Anemia / Q000175:diagnosis / Q000209:etiology*; D000818:Animals; D005002:Ethiopia; D005260:Female; D006801:Humans; D007865:Leeches; D010272:Parasitic Diseases / Q000150:complications* / Q000175:diagnosis; D017698:Postmenopause; D012769:Shock / Q000175:diagnosis / Q000209:etiology*; D014592:Uterine Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D014621:Vagina / Q000473:pathology
keywords: Ethiopia; postmenopausal vaginal bleeding; vaginal leech infestation