Leech therapy of hemorrhoids causes Anal abscess: mumbo jumb
Anorectal sepsis usually presents with anal abscesses, which may evolve to become anorectal fistulas. Most of these cases are either of cryptoglandular origin, or they develop secondary to inflammatory bowel diseases. This is a case of anal abscess which developed acutely following leech therapy of hemorrhoids.

A 32-year-old male patient applied to the Proctology Unit with severe anal pain and swelling which gradually increased during the last 48 hours. He had suffered from hemorrhoidal disease for the last few years, and three days before he reported, leeches were applied to the hemorrhoidal swellings in a small medical center. The patient was febrile (38.5°C) and restless. Proctologic examination revealed a painful swelling on the posterior midline, around which the leech bites could be seen. He was immediately hospitalized, and a rapid pelvic MR, blood tests and anesthesia with epidural catheter were organized.

Blood tests revealed a WBC count of 22 000/ml and sedimentation rate of 80 mm/h. A posterior perianal midline fluid collection measuring up to 4 × 3 cm was detected on MRI. The collection had thick and strongly enhancing walls with central diffusion restriction on diffusion weighted series, consistent with abscess. Inflammatory findings around the abscess were affecting both sides of the natal cleft.

Source: Journal of surgical case reports

Read more: https://academic.oup.com/jscr/article/2019/7/rjz218/5541846