Sunarays Akhtar, Inamul Haq.
An experience with leeches in the aerodigestive tract.
Pak Armed Forces Med J Jan ;56(3):321-4.

A seven year old girl was brought with four days history of cough with blood stained sputum after drinking water from a pond. She also developed pain in her throat and was unable to swallow except for liquids. She was taken to a local doctor who gave her some antibiotics. Despite treatment the cough did not settle and she continued to cough out, spit and vomit blood. After 3 days of treatment the parents brought her to C.M.H Zhob in a state of acute respiratory distress. On presentation the child was dyspnoeic, slightly cyanosed and exhausted due to prolonged coughing and respiratory distress. On examination the child was afebrile how ever pale looking and cyanosed. She was tachypnoeic and had harsh vesicular breath sounds. There was pooling of saliva in the oral cavity. Her coagulation profile was with in normal limits however her hemoglobin level was 9 g/ dl. X-ray of the neck lateral view showed a soft tissue shadow just below the epiglottis (fig. 2) and the chest X-ray was normal. A provisional diagnosis of partial air way obstruction due to foreign body in the upper airway was made and an emergency laryngoscopy was planned under general anesthesia. On direct laryngoscopy a leech was found attached to the right pyriform fossa with its one end in the glottis which was removed immediately. The patient made a smooth postoperative recovery. On recovery the patient had no dyspnea, stridor or dysphagia and was discharged the next day on oral antibiotics.

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