Scrotal Hirudiniasis: The Mysterious Migration of a Leech Into the Scrotum: A Case Report.

Hirudiniasis, or leech infestation, is a rare parasitic condition typically involving external skin or mucosal surfaces. We report a case of scrotal hirudiniasis, an 11 cm long leech discovered within the scrotal sac of a 15-year-old male. He initially developed hematuria due to periurethral leech attachment, which resolved following catheterization and bladder irrigation. A week later, he presented with acute scrotal pain and swelling. Ultrasound revealed a tubular, mobile structure near the left vas deferens. Surgical exploration identified an 11 cm leech within the tunica vaginalis, without any external entry wound or urethra-cutaneous fistula. Two plausible routes of entry are suggested: retrograde movement via the vas deferens or migration through perineal fascial planes following urethral breach. This case underscores the need to consider unusual parasitic causes in patients presenting with acute scrotum in endemic regions.