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Prolonged venous bleeding due to traditional treatment with leech bite: a case report
© Kaya et al; licensee BioMed Central Ltd. 2011
Received: 21 October 2010
Accepted: 6 May 2011
Published: 6 May 2011
The medicinal leech, Hirudo medicinalis, has been used in the treatment of many diseases for thousands of years. In Turkey, it is used most commonly in the management of venous diseases of lower extremities.
A 25-year-old Turkish woman presented to our emergency room with bleeding from her left leg. She had been treated for varicose veins in her lower extremities with leeches about 24 hours before admission to the emergency room. The bleeding was controlled by applying pressure with sterile gauze upon the wound, and she was discharged. She returned after four hours having started bleeding again. Hemostasis was achieved by vein ligation under local anesthesia.
Leech bite should be evaluated as a special injury. Prolonged bleeding can be seen after leech bites. In such cases, hemostasis either with local pressure or ligation of the bleeding vessel is mandatory.
Leeches are bloodsucking worms usually found in places with fresh water. There are two species of therapeutic leeches, Hirudo medicinalis (European medical leech) and Hirudo michaelseni. H. medicinalis is about 10 cm in length and 2 g in weight. They have been used for the treatment of many diseases as far back as 2,500 years ago. Headaches, hemorrhoids, and mental illness are some of the disorders that have been treated with leeches.
Treatment with leeches is referred to as hirudotheraphy in modern medicine. Today, medicinal leech therapy is mainly used in plastic surgery and reconstructive surgery for tissue flap salvage . Medicinal leech therapy in Turkey is a traditional treatment for venous disorders of the lower extremities. Most patients get symptomatic relief with this treatment. Leeches are placed onto the lower extremities and they suck the accumulated blood from the dilated veins.
Here, we report the case of a patient with prolonged bleeding after medicinal leech bites. We were able to control the bleeding in our patient by ligation of the punctured, dilated veins with an operation under local anesthesia. We believe that this is the first case report in the English literature concerning prolonged bleeding after leech bite in the treatment of venous disease of the lower extremities.
After completing hemostasis, the skin was sutured with 3/0 prolene. Our patient was examined seven days after her operation. The wound was clear without any complication.
H. medicinalis has two suckers, one in its anterior and one in its posterior region. They usually feed via the anterior suckers in a process that lasts about 20 to 40 minutes. They can suck 10-15 ml of blood and may increase their body size eight to 11 times.
Chemical substances produced by leeches
Breakdown of connective tissue.
Leeches are commonly used in Turkey in medical treatment of venous congestion of the lower extremities. A diagnosis of leech bite can be made easily. Patients usually have a history of medicinal leech therapy. If a leech is found at the bite site, it can be removed with the use of table salt, vinegar or lignocaine solution.
Bleeding after leech bite in different parts of the body has been reported [3–6]. Leech bite may be associated with morbidity such as serious bleeding and skin infection. Anemia can often be seen with leech infestation. Erysipelas and skin abscess with Mycobacterium marinum may also be seen in patients with leech bite. Skin wounds may heal with scar formation. Aeromonas hydrophila is a bacterium that can live with leeches symbiotically. It can cause infection after leech bite. Antibiotic prophylaxis in medicinal leech treatment may be recommended. Although it is rare, leech bite may also cause death .
Prolonged bleeding after leech bite should be treated seriously. Some bleeding may require transfusion due to loss of large amounts of blood. There are several methods to treat prolonged bleeding after leech bite. Pressure with sterile gauze on the wound is the simplest method. In cases of sustained bleeding, sterile gauze soaked in a thrombin solution can be applied. Desmopressin (1-deamino-8-D-arginine vasopressin; DDAVP) has been reported as an effective agent in controlling bleeding in rats after hirudin infusion . Our patient was treated by applying pressure with sterile gauze upon the wound on her first admission. The bleeding stopped. The patient was admitted again to the emergency room with recurrent bleeding after four hours. Hemostasis was achieved by vein ligation under local anesthesia.
Leech bite can cause prolonged bleeding. It may even result in death due to blood loss. Leech bite should be evaluated as a special injury with the risk of prolonged bleeding.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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