A Rare Cause of Hypovolemic Shock in Prepubertal Girl: Vagin
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Vaginal bleeding in girls is an alarming symptom for both parents and pediatricians. Serious underlying causes should be always evoked.

A 9-year-old girl was admitted for vaginal bleeding spanning 10 days and severe anemia. She was initially treated by a general practitioner with oral antibiotics as a vulvovaginitis. Abdominal and pelvic ultrasound scan was normal. But, due to the persistence of vaginal bleeding and worsening of her condition, she was referred to the paediatric emergency department. She was acutely sick and had pale teguments.

The child was managed as a hypovolemic shock and resuscitated with intravenous fluids and urgent blood transfusion. Gynecological examination found a live leech at the vulva on the fourchette; its extraction was facilitated by applying a saline solution. The mother was interrogated for a second time, and she revealed that the symptomatology appeared after a long day of swimming in a pond. The evolution saw a spectacular improvement and a stop to the bleeding. The child was clinically stable and discharged home the next day with ambulatory treatment.

Diagnosis of a leech bite can be made simply with the patient’s history and clinical examination. The genital exam was insufficient and the patient was treated as a vulvovaginitis, without any improvement. This eventually led to the development of a severe life-threatening anemia. In most of the cases, the leech’s removal can be facilitated by applying a saline solution. Its removal by surgical forceps has also been reported. But, the leech should not be forcibly removed because its jaws may remain in the wound, causing continuous bleeding and infection. The leech, in this case, was simply dislodged by irrigation with a saline solution.

Vaginal leech infestation in girl can cause a life-threatening hypovolemic shock secondary to continuous vaginal bleeding. Thus, in patients presenting vaginal bleeding, it is of utmost importance to take a good history and perform a thorough physical examination.

Source: https://www.hindawi.com/journals/criog/2019/3459837/