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A recent odd visit which made the news...
A healthy 9 year old presented with acute onset of upper GI bleed. Woke in the morning with a large hematemesis, on the way to the hospital another large one (about 100cc in a plastic bag) and the third one while being examined - bright red blood, no gastric contents.  Negative history for everything. Hemodynamically stable, normal PE. NG tube had continuous draining of bright red blood.  After about an hour went for urgent endoscopy, about an hour later the gastroenterology shows up white and shaken looking.  He put down the scope and saw something black on the anterior aspect of the upper esophagus which then proceeded to move! Not really thinking, he took the forceps and yanked it off.  It turned out to be a 3cm long leech! The child had a large gastric ulceration - apparently the leech attached itself to the stomach mucosa and when the child started bleeding and vomiting, partially dislodged the leech which then reattached itself to the esophageal mucosa.  It turns out the child went swimming 5 days earlier in a stream known to be leech infested and apparently swallowed a little one.  Uneventful recovery, I think the child recovered faster than the gastroenterologist.

Lisa Amir
Schneider Children's Hospital of Israel

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Amy Baxter
Sent: Wednesday, August 26, 2009 3:54 AM
To: [log in to unmask]
Subject: Re: Odd visits

Oh, this is always such a fun topic!  It leavens the intensity of
flu/respiratory volume we're seeing.

OK, my favorite chief complaint also involved a perfectly well looking
five year old with the chief complaint of "missing testicles".  Quoth the
mom, who came in one cold winter morning in Cincinnati, "I gave him a
bath, so I know they were there last night!"

Jay Fisher <[log in to unmask]> writes:
>Back in the Mesozoic Period I helped start up a Peds ED in a suburban 
>community. I was a little nervous about it's viability and became even
>more 
>so when I the first patient in the dept's history.
>
>It was a diaper.
>
>A father brought in his child's diaper for me to examine (child at home 
>sleeping comfortably).
>
>It was urate crystals.
>
>Talk about an inauspicious beginning.
>
>Jay
>
>Jay D. Fisher MD FAAP
>Director of Pediatric Emergency Services
>Emergency Physicians Medical Group
>University Medical Center, Las Vegas NV
>St. Rose Sienna Hospital, Henderson NV
>
>For more information, send mail to [log in to unmask] with the
>message: info PED-EM-L
>The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
>



Amy Baxter MD
Pediatric Emergency Medicine Associates
404 371-1190


For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html