International journal of surgery case reports · 2026
Coincidental occurrence of endometrial hyperplasia with atypia and vaginal leech infestation in a postmenopausal woman: a rare case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Negasi Gebreslase Musie, Reta Birhanu Kassie, Sisay Henock Solomon, Girmay Haftom Guesh, Hailu Kibrom Tsegay, Alemu Selamawit Muluken
Аннотация
BACKGROUND: Postmenopausal bleeding is a common gynecological complaint with multiple etiologies, ranging from benign to malignant conditions. Leech infestation of the female genital tract is a rare cause, particularly in rural regions with exposure to natural pooled water sources.
CLINICAL PRESENTATION: We report a 50-year-old postmenopausal woman who presented with a 1-week history of vaginal bleeding. Ultrasound evaluation revealed a thickened endometrium (20 mm), and histopathology confirmed endometrial hyperplasia with atypia. She underwent total hysterectomy with bilateral salpingo-oophorectomy. Unexpectedly, persistent postoperative vaginal bleeding revealed a live leech attached to the vaginal vault, which was removed successfully with saline irrigation and forceps.
CLINICAL DISCUSSION: The coexistence of both conditions poses a diagnostic challenge, as one condition can obscure the other. Leech attachment causes prolonged bleeding through its anticoagulant secretions, and its presence should be suspected in women from rural settings. A careful speculum examination remains crucial even when another etiology has been established.
CONCLUSION: This case illustrates a rare coexistence of two distinct causes of vaginal bleeding: endometrial hyperplasia with atypia and vaginal leech infestation. In women from rural areas with exposure to contaminated water, clinicians should maintain a high index of suspicion for leech infestation even when another cause of bleeding is established.
CLINICAL PRESENTATION: We report a 50-year-old postmenopausal woman who presented with a 1-week history of vaginal bleeding. Ultrasound evaluation revealed a thickened endometrium (20 mm), and histopathology confirmed endometrial hyperplasia with atypia. She underwent total hysterectomy with bilateral salpingo-oophorectomy. Unexpectedly, persistent postoperative vaginal bleeding revealed a live leech attached to the vaginal vault, which was removed successfully with saline irrigation and forceps.
CLINICAL DISCUSSION: The coexistence of both conditions poses a diagnostic challenge, as one condition can obscure the other. Leech attachment causes prolonged bleeding through its anticoagulant secretions, and its presence should be suspected in women from rural settings. A careful speculum examination remains crucial even when another etiology has been established.
CONCLUSION: This case illustrates a rare coexistence of two distinct causes of vaginal bleeding: endometrial hyperplasia with atypia and vaginal leech infestation. In women from rural areas with exposure to contaminated water, clinicians should maintain a high index of suspicion for leech infestation even when another cause of bleeding is established.