Esophageal hirudiniasis: an unusual cause of upper gastrointestinal bleeding

Leeches are carnivorous, hermaphroditic, segmented worms mainly found in fresh water. The majority of leech attachments are external and short-lasting. Internal surfaces can be involved. Yet, esophageal attachment is very rare. We report a case of a 59-year-old female who presented with hematemesis, melena and chest pain. Upper gastrointestinal endoscopy revealed a round black foreign body in the mid-third of the esophagus identified as a leech. We carefully extracted the worm with a forceps applied to the middle of its body. The diagnosis of leech infestation should be kept in mind when exploring gastrointestinal bleeding in patients living in rural areas and those with poor living conditions. Plain language summary: Sanguinivorous leeches are a subgroup of annedlids that occasionally enter the human body through natural orifices and cause internal bleeding depending on the attachment site. This article presents a rare case of gastrointestinal bleeding caused by an esophageal leech infestation in a 59-year-old woman. The worm was carefully extracted with a forceps and the patient was educated about the danger of consuming or swimming in untreated water. Leech infestation should be kept in mind as a differential diagnosis when exploring gastro-intestinal bleeding or anemia in leech-endemic areas.