[Factitious gastrointestinal hemorrhage in 3 school-age girls]

Three female patients aged 9, 13 and 14 years, respectively, seen by the authors over a 1-year period presented with the complaint of recurrent hematemesis (2 patients) or melena (1 patient). The (presumed) bleeding episodes had only been seen by the respective patient and one parent (the mother in two cases and the father in one). In two cases, the other parent was antagonistic with the reported situation. A clear symbiosis had been forged between the index case and the allied parent. Two patients had previously been seen in several hospitals and had undergone various diagnostic tests, including esophagogastroduodenoscopies, all of which had proved normal. Two girls had attempted suicide. Two of the mothers had a depressive disorder. Re-evaluation of the patients by the authors again ruled out any cause for the presumed bleeding or any sequelae originating from it. The patients and their parents were referred to a psychiatric service but this was only complied by one family; the other two repeatedly avoided attending the psychiatric clinic. Awareness of this pattern of presentation and of the psychiatric profiles of the patients and their families is critical for practitioners in order to recognize factitious illness whenever a patient with a history of gastrointestinal bleeding presents with incongruous or illogical medical history and clinical findings.