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Factitious Disorder Presenting with Refractory Enterocutaneous Fistula that Underwent 7 Surgeries
Di Zhao1, Qiyi Chen1, Ning Li1
1Department of Colorectal Disease, The No.10 People's Hospital of Shanghai, Shanghai, China.
Case Reports in Gastroenterology
|June 30, 2020
Summary
A rare post-appendicectomy fistula case was initially treated extensively. The patient was later diagnosed with factitious disorder after self-inflicting a wound to simulate a fistula, highlighting a rare but important clinical consideration.
Area of Science:
- Gastroenterology
- Surgical Complications
- Psychiatry
Background:
- Post-appendicectomy fistula is a rare but severe complication.
- Common causes include stump leakage, neoplasm, infection, inflammatory bowel disease, and obstruction.
- Standard management involves nutritional support, drainage, antibiotics, and surgical intervention.
Observation:
- A young female presented with a refractory enterocutaneous fistula post-appendicectomy.
- Despite comprehensive treatment, her condition persisted and showed discrepancies with diagnostic findings.
- Clinical suspicion shifted towards factitious disorder due to persistent, unexplained symptoms.
Findings:
- The patient confessed to applying feces to her wound to simulate a fistula.
- This case highlights a rare presentation of factitious disorder mimicking surgical complications.
- Factitious disorder has an estimated lifetime prevalence of 0.1% in the general population.
Implications:
- Clinicians must consider factitious disorder in refractory cases with incongruent findings.
- Awareness of factitious disorder is crucial for accurate diagnosis and appropriate patient management.
- This case underscores the importance of a multidisciplinary approach in complex surgical complications.
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