Massive hematemesis in a child due to leech infestation

Introduction: Leech infestation is a rare cause of gastrointestinal bleeding in children. Leeches are parasitic annelids belonging to the subclass Hirudinea, commonly found in freshwater environments. Human infestation typically occurs through ingestion of contaminated water or exposure during swimming. Diagnosis and management often require endoscopic intervention unless spontaneous expulsion occurs. Clinical case: We present the case of a 5-year-old girl with no significant medical history, admitted to the pediatric emergency department of the Marrakech University Hospital with massive hematemesis. Clinical examination revealed severe pallor, asthenia, and signs of hemodynamic instability, including tachycardia and polypnea. Laboratory tests showed severe anemia (Hb: 4 g/dL), necessitating packed red blood cell transfusion. After stabilization, the child experienced another episode of vomiting, during which a leech was expelled. Subsequent upper gastrointestinal endoscopy revealed no mucosal lesions. Conclusion: Leech infestation is an uncommon but important cause of gastrointestinal bleeding in children, particularly in developing regions. Clinicians should consider it as a differential diagnosis in cases of unexplained hematemesis, especially in patients with a history of non-potable water consumption. Keywords: leech, children, bleeding, expulsion.