An Unusual Cause of Respiratory Distress: Live Leech in the Larynx

Abstract

Aforeign body in the respiratory tract is an emergency and requires immediate attention, because the ensuing airway obstruction may cause hypoxia and death. We are reporting the successful management of a case in which a live leech was in the larynx, causing respiratory distress. The presence of a live foreign body should be included as a differential diagnosis of acute onset respiratory distress in areas where drinking pond and river water is common. Case Report A 48-yr-old man who was cyanotic, arrived in our emergency room with complaints of severe breathlessness and difficulty in speaking. On examination, he had inspiratory stridor with bilateral decreased air entry. His history from relatives revealed that he had never had any respiratory problems and was symptomatic for the previous 3 h only. After drinking water from the river, he developed gradually progressive dyspnea. Based on history and presentation, a foreign body in the pharynx was suspected. Indirect laryngoscopy was performed in the emergency room, and a moving object was seen between the vocal cords. Direct laryngoscopy was performed without anesthesia. A small thin mobile foreign body was seen protruding from between the vocal cords (Figure 1). While attempting to remove it with forceps, the object became attached to the forceps and was taken out. It was a live leech measuring 5 cm × 0.5 cm. The patient experienced immediate relief from breathlessness and started speaking normally but with a husky voice. He was discharged from the hospital on the same day without complication.Figure 1: Illustrated diagram showing the site of lodgment and position of the leech before removal.Discussion Various foreign bodies have been found in the pharynx and esophagus. Adults may accidentally swallow pieces of meat, dentures, and bones. Children may swallow objects out of curiosity, whereas psychotics may swallow an article deliberately (1). Fish bones are the most common foreign body found in the throat (2). A few cases of live foreign bodies in the throat have also been reported (2–4). An interesting case of a live foreign body in which a fisherman accidentally swallowed a fish and developed upper airway obstruction and its successful piecemeal removal is described by Rajendran et al. (3). Khan (4) reported the extraction of Koi fish that obstructed the airway. The peculiarity of this case was that fish was alive at the time of removal. Labadi and Jaml (5) reported two cases of a live leech in the larynx, causing severe attacks of inspiratory stridor, cyanosis, dysphagia, cough, and spitting of blood for five days to two weeks. The exact manner in which the leech reached the larynx in our case is not known. We presumed that the leech lodged in the hypopharynx when the patient drank from the river. The small, young leech became lodged in the oropharynx or hypopharynx, where it migrated into the laryngeal inlet and produced respiratory obstruction that was quickly diagnosed and properly managed. Removal of a leech requires special care and the utmost gentleness because it attaches strongly with its suckers. A strong grip and force are required to remove it from its attachment surface. Because of its soft and slippery body surface, which ruptures easily, it is difficult to hold a leech with force. We were fortunate in removing this live leech because its suckers were facing upward at the time of removal, and it automatically attached to the forceps. We suggest that when a patient reports progressive respiratory distress of unknown etiology and of acute onset, without a previous history of respiratory problems, the possibility of a foreign body, even a live foreign body, should be suspected, and attempts should be made to remove it immediately.