Leeches are carnivorous, hermaphrodite, segmented worms that belong to phylum Annelida, Class Hirudi-nea. Aquatic leeches can inhabit both fresh and saltwater bodies, most commonly relatively still waters, sluggish streams and paddy fields. Leeches can vary from 5 to 15 cm in length. A leech has two suc-kers, one at each end. The mouth lies within the anterior sucker. Blood-sucking species have jaws in the anterior sucker that contain chitinous teeth for biting. Hemophagic species engorge and darken during blood sucking
4-5. They may enter the body via the excre-tory openings of individuals who drink or bathe in infested waters, causing subsequent internal hirudiniasis
6. Possible sites of leech infestation are nasal cavity, oropharynx, hypopharynx, larynx, trachea, esophagus, vagina, urethra and rektum
3-7.
When lodged in the oropharynx, the leech is able to simulate the symptoms of angio-edema. Signs of mechanical obstruction, including unilateral nasal obst-ruction, dysphagia, dysphonia, or dyspnea can progress in time, since the leech will increase its size during the period of feeding. In this case, the patient had dysphagia3-8. This foreign body, in the respiratory tract is an emergency and requires immediate attention because the ensuing airway obstruction may cause hypoxia and death6. Severe anemia and cardiovascular fin-dings may be observed depending on the severity of mucosal damage9.
The strong attachment of the leech to the mucosa necessitate minuteness and caution during removal, which can be managed under general or topical/local anesthesia. Injection of local anesthetic or topical toxic agents have been proposed to detatch leech from mucosa10. However, they should be applied cautiously in order to avoid any mucosal edema and bleeding. Bilgen et al have reported that they used topical anest-hetic agents, such as lidocain to paralize the leech11. Contrarily, Kuehnemund et al have removed the leech using a forceps without any complication2. Oghan et al3 have used electrocautery to remove the leech. General anesthesia is typically endicated for the diag-nosis and removal of leeches localized in the mucosa of larynx, hypopharynx, upper pharynx and upper digestive system11. In our case, the leech was removed from the posterior oropharynx under general anesthesia using blunt forceps, without electrocautery.
Leech infestation should be considered in the dif-ferential diagnosis of pediatric patients presented with soar throat, dysphagia and hemoptysis in developing countries. Boiling water from rural supplies should be encouraged to prevent infestations.
)
)