Coincidental occurrence of endometrial hyperplasia with atypia and vaginal leech infestation in a postmenopausal woman: a rare case report

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.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

A 50-year-old postmenopausal woman with endometrial hyperplasia with atypia had persistent vaginal bleeding after hysterectomy until a live leech attached to the vaginal vault was discovered and removed with saline irrigation and forceps.

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