[A case of secret self-mutilation--artificial hand edema by hand self-constriction]

Edema caused by surreptitious self-mutilation leads to special diagnostic and therapeutic problems because the causal psychic illness is not immediately obvious or appears insignificant due to the diagnosis of edema and the frequent desire of the patients for invasive measures. The quickest clarification is achieved by contacting an experienced lymphologist, who can often classify the swelling as artificial edema at a glance. In order to avoid any secondary damage arising from the edema, it should be reduced as quickly as possible by referring the patient to a lymphological clinic for therapy. Thus, invasive diagnostics would certainly be avoided, and the patient's desire for invasive procedures circumvented by conservative therapy. A psychiatric/psychosomatic specialist must be consulted. Cooperation between patient, physicians in practice and hospital should be established as early as possible. In difficult cases, the patient should be referred to a psychiatric hospital. Even for the experienced lymphologist, cases in which Sudeck's disease in the congested extremity has to be taken into account and the compliance of the patient is restricted present particular problems.