Munchausen's syndrome

Abstract

Case presentation A 34-year-old single man presented to the accident and emergency department with a history of fever and bilateral loin pain. On arrival, he gave the triage nurse a bloodstained urine sample in a beaker. On examination he had a tender abdomen and several abdominal scars from previous laparotomies. Blood samples were taken, and an abdominal radiograph was arranged. While waiting for these tests, a staff nurse in the department recognised the patient from another hospital and reported that when he had been seen there the staff had thought that he was faking his symptoms. Contact with that hospital confirmed this view. Over a period of 6 months the patient had apparently presented on three separate occasions with an acute abdomen. On the first two occasions, he had been admitted for observation and further investigations, including numerous radiographs, ultrasound scans, and an intravenous pyelogram, all of which proved negative. Despite these findings he underwent an exploratory laparotomy because his problems were thought to be related to adhesions, a complication of previous surgery. By the time of his third admission he was so well known that he was recognised by the nursing staff, at which point he absconded. With this knowledge, the patient was confronted by the accident and emergency staff, after which he admitted to falsifying his symptoms and signs. A psychiatric referral was suggested, to which he was agreeable. However, by the time the psychiatrist had arrived, the patient had disappeared from the department. A 34-year-old single man presented to the accident and emergency department with a history of fever and bilateral loin pain. On arrival, he gave the triage nurse a bloodstained urine sample in a beaker. On examination he had a tender abdomen and several abdominal scars from previous laparotomies. Blood samples were taken, and an abdominal radiograph was arranged. While waiting for these tests, a staff nurse in the department recognised the patient from another hospital and reported that when he had been seen there the staff had thought that he was faking his symptoms. Contact with that hospital confirmed this view. Over a period of 6 months the patient had apparently presented on three separate occasions with an acute abdomen. On the first two occasions, he had been admitted for observation and further investigations, including numerous radiographs, ultrasound scans, and an intravenous pyelogram, all of which proved negative. Despite these findings he underwent an exploratory laparotomy because his problems were thought to be related to adhesions, a complication of previous surgery. By the time of his third admission he was so well known that he was recognised by the nursing staff, at which point he absconded. With this knowledge, the patient was confronted by the accident and emergency staff, after which he admitted to falsifying his symptoms and signs. A psychiatric referral was suggested, to which he was agreeable. However, by the time the psychiatrist had arrived, the patient had disappeared from the department.