an unus ual presentation of leech leading to severe hemat emesis in an infant

a nine month old infant was taken to a rural medical center due to hematemesis and melena. the bleeding persisted in spite of active management with gastric lavage, intravenous cimetidine, antiacid therapy and blood transfusion for four days' duration. the patient was referred to our center for further evaluation and management. on arrival he was pale and ill looking with active bleeding from the mouth. physical examination was negative except for the presence of a leech attached to the posterior pharyngeal wall the bleeding stopped soon after the removal of the leech and the patient was discharged from the hospital in good condition shortly thereafter.