Summary
We present a case of haematemesis and malaena, severe enough to require blood transfusion, caused by leech infestation from the southern region of Saudi Arabia. The site was the posterior pharyngeal wall. The common mode of presentation in leech endoparasitism is by nasal infestation and recurrent unexplained epistaxis. Leech endoparasitism should be considered as a cause in unexplained haematemesis in areas where aquatic leeches are commonly found.