Medico-Legal Issues of a Leech Bite in a Premenarcheal Child

Abstract

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Introduction Vaginal bleeding after first week o f life, but before menarche, is always abnormal and needs diagnostic evaluation. This may be the first evidence o f sexual abuse. False allegations and suspicion among guardians may lead to serious consequences on the child as well as the suspects. Case history An eight month old baby living in a rubber estate was presented with sudden onset vaginal bleeding for two days. Bleeding disorders were excluded and the child was referred to a Judicial Medical Officer (JM O) to exclude sexual abuse. Medico-legal examination done on the third day after the incident revealed 1.2cm x 1cm bleb o f hemorrhage on labia minora. An isolated underlying 0.5cm abrasion appeared to cause active bleeding. There was no past history o f similar episodes. Grandmother named a few suspects and alleged sexual abuse. Later, mother mentioned that a leech was found in the room a few hours after the incident. Conclusions Unusual vaginal bleeding in children should be investigated thoroughly to achieve justice, exclude false allegations and protect children and guardians from stigma. Forensic pathologists must be aware o f fauna o f thier working area because they could cause medico-legally significant injuries.