Meta analysis of the leech as a live foreign body: detection, precaution and treatment.Pak J Biol Sci. 2009 Dec 15; 12(24):1556-63.PJ
Foreign body in the esophagus is a common emergency presentation. Foreign body aspirations comprise the majority of accidental deaths in childhood. Conventional x-ray imaging is usually obtained to aid the diagnosis during the initial evaluation. The decision for surgical intervention is usually based on a suspicious history, physical examination and radiologic findings. Rigid bronchoscopy is very effective procedure for inhaled foreign body removal with fewer complications. Proper use of diagnostic techniques provides a high degree of success and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory. Live foreign body is a rare entity but common emergency presentation. The approach towards a patient with leech infestation comprises a thorough history and systematic examination followed by relevant investigations. However, there is considerable debate over the most appropriate treatment option for such patients. A living foreign body, or parasite, in the oro-or naso-pharynx is rare in Western countries, but in other parts of the world is a fairly common cause of problems. In the past 10 years 28 cases of foreign bodies due to infestation with leeches were treated in our departments. In all patients, 2-70 years old, the complaint was of recurrent episodes of epistaxis, blood-spitting, odynophagia, dysphagia, dyspnea and hemoptysis several days before admission. Examination showed a green-brown mass protruding from different naso- and oro-pharengeal areas, which is in every case, was a blood-engorged leech. Treatment consisted of removing the leech by applying a forceps to the middle of the leech's body and giving a quick pull. Bleeding ceased immediately after removal of the leech. This review aims to develop a comprehensive approach towards patients presenting with foreign body ingestion by developing clinical practice guidelines. These guidelines address not only the initial evaluation of the patient but also the various management alternatives and their advantages, limitations and applicability in various scenarios, based upon a review of the literature.