Coincidental occurrence of endometrial hyperplasia with atypia and vaginal leech infestation in a postmenopausal woman
Case report published in International Journal of Surgery Case Reports (2026)
Abstract
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.
Resumen
Rare case of vaginal leech infestation in a postmenopausal woman with concurrent endometrial hyperplasia — discusses removal technique and gynecologic workup.
Por qué esto importa para la hirudoterapia
Este caso clínico describe a una mujer posmenopáusica de 50 años con hiperplasia endometrial con atipia en quien se encontró inesperadamente una sanguijuela viva adherida a la bóveda vaginal tras un sangrado persistente posthisterectomía, lo que requirió irrigación con solución salina y extracción con pinzas. El resumen señala que las secreciones anticoagulantes de la sanguijuela causan sangrado prolongado, una propiedad farmacológica central de la hirudoterapia. Sin embargo, el contexto es enteramente de infestación parasitaria accidental por exposición a aguas estancadas naturales en un entorno rural, sin aplicación terapéutica de sanguijuelas. Se trata de un caso clínico aislado que resalta el desafío diagnóstico más que el uso terapéutico. Su relevancia para el ámbito de la ASH se limita a la breve mención de las secreciones anticoagulantes como mecanismo del sangrado.
Citación
Coincidental occurrence of endometrial hyperplasia with atypia and vaginal leech infestation in a postmenopausal woman.
Negasi Gebreslase M et al. · International journal of surgery case reports, 2026
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026