This case is presented to show that hypovolumic shock and severe anemia secondary to vaginal bleeding in a woman of postmenopausal age group residing in rural areas could be caused by vaginal leech infestation and thus care providers should consider it when dealing with postmenopausal uterine bleeding. The causes of vaginal bleeding in post menopausal women include exogenous estrogens, atrophic endometritis, atrophic vaginitis, endometrial or cervical cancer and polyps, uterine sarcoma, urethral caruncles and trauma ( 1, 8). It accounts for about 5% of office gynecology visits ( 7). Postmenopausal bleeding refers to uterine bleeding in a menopausal woman. It may cause serious complications like lethal dyspnoea, haemoptysis, epistaxis, haematemesis, anemia or even death ( 3, 4, 5). The most common symptom of leech infestation is continuous bleeding from sites of attachment. These chemicals play great roles in pathogenesis of leech infestation ( 6). Leeches possess different chemicals such as proteolytic inhibitors e.g hirudin, anesthetic, vasodilators and hyaluronidase. They commonly affect children and people who live in unhygienic environments ( 2.) They attach to their hosts and remain there ( 5). There are reported leech infestations in various human body sites such as the nose, pharynx, larynx, esophagus, rectum and bladder ( 2). Leeches are usually taken into the human body when using unfiltered or contaminated water to bathe, to drink, or to swim ( 3, 4). They are found in lakes, slow moving streams, ponds and marshes, and on moist vegetation in humid environments such as jungles ( 1, 2). They belong to the phylum Annelida, class Hirudinea. Leeches are blood sucking water worms and are parasitic to man and other animals.
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