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Munchausen's syndrome presenting as rectal foreign body insertion: a case report.

Khan SA, Davey CA, Khan SA, Trigwell PJ, Chintapatla S - Cases J (2008)

Bottom Line: A description and summary of current knowledge about the condition is also provided, including appropriate treatment approaches.This would result in the appropriate course of action, with regard to treatment, not being followed.Early involvement of psychiatrists is recommended.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Liaison Psychiatry, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK. peter.trigwell@leedsth.nhs.uk.

ABSTRACT

Background: This case report shows that Munchausen's syndrome can present as rectal foreign body insertion. Although the presentation of rectal foreign bodies has frequently been described in the medical literature, the insertion of foreign bodies into the rectum for reasons other than sexual gratification has rarely been considered.

Case presentation: A 30 year old, unmarried Caucasian male presented with a history of having been sexually assaulted five days earlier in a nearby city by a group of unknown males. He reported that during the assault a glass bottle was forcibly inserted into his rectum and the bottle neck broke. On examination, there was no evidence of external injury to the patient. Further assessment lead to a diagnosis of Munchausen's syndrome. The rationale for this is explained. A description and summary of current knowledge about the condition is also provided, including appropriate treatment approaches.

Conclusion: This case report is important because assumptions regarding the motivation for insertion of foreign bodies into the rectum may lead to the diagnosis of Munchausen's syndrome being missed. This would result in the appropriate course of action, with regard to treatment, not being followed. It is suggested that clinicians consider the specific motivation for the behaviour in all cases of rectal foreign body insertion, including the possibility of factitious disorder such as Munchausen's syndrome, and avoid any assumption that it has been carried out for the purpose of sexual gratification. Early involvement of psychiatrists is recommended. Cases of Munchausen's syndrome presenting as rectal foreign body insertion may be identified and addressed more effectively using the approach described.

No MeSH data available.


Related in: MedlinePlus

Endoscopic snare with bottle fragment.
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Figure 2: Endoscopic snare with bottle fragment.

Mentions: The patient refused a rectal examination on the ward. On examination under anaesthesia, in the lithotomy position, no evidence of perianal trauma was found. A flexible endoscope was inserted and the broken glass bottle was confirmed to be in the sigmoid colon. An endoscopic snare was passed and the broken glass bottle retrieved (Figure 2). Repeat endoscopy did not show any damage to the mucosa. The neck of the glass bottle was found to have a roll of paper inserted within it (Figure 3).


Munchausen's syndrome presenting as rectal foreign body insertion: a case report.

Khan SA, Davey CA, Khan SA, Trigwell PJ, Chintapatla S - Cases J (2008)

Endoscopic snare with bottle fragment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572607&req=5

Figure 2: Endoscopic snare with bottle fragment.
Mentions: The patient refused a rectal examination on the ward. On examination under anaesthesia, in the lithotomy position, no evidence of perianal trauma was found. A flexible endoscope was inserted and the broken glass bottle was confirmed to be in the sigmoid colon. An endoscopic snare was passed and the broken glass bottle retrieved (Figure 2). Repeat endoscopy did not show any damage to the mucosa. The neck of the glass bottle was found to have a roll of paper inserted within it (Figure 3).

Bottom Line: A description and summary of current knowledge about the condition is also provided, including appropriate treatment approaches.This would result in the appropriate course of action, with regard to treatment, not being followed.Early involvement of psychiatrists is recommended.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Liaison Psychiatry, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK. peter.trigwell@leedsth.nhs.uk.

ABSTRACT

Background: This case report shows that Munchausen's syndrome can present as rectal foreign body insertion. Although the presentation of rectal foreign bodies has frequently been described in the medical literature, the insertion of foreign bodies into the rectum for reasons other than sexual gratification has rarely been considered.

Case presentation: A 30 year old, unmarried Caucasian male presented with a history of having been sexually assaulted five days earlier in a nearby city by a group of unknown males. He reported that during the assault a glass bottle was forcibly inserted into his rectum and the bottle neck broke. On examination, there was no evidence of external injury to the patient. Further assessment lead to a diagnosis of Munchausen's syndrome. The rationale for this is explained. A description and summary of current knowledge about the condition is also provided, including appropriate treatment approaches.

Conclusion: This case report is important because assumptions regarding the motivation for insertion of foreign bodies into the rectum may lead to the diagnosis of Munchausen's syndrome being missed. This would result in the appropriate course of action, with regard to treatment, not being followed. It is suggested that clinicians consider the specific motivation for the behaviour in all cases of rectal foreign body insertion, including the possibility of factitious disorder such as Munchausen's syndrome, and avoid any assumption that it has been carried out for the purpose of sexual gratification. Early involvement of psychiatrists is recommended. Cases of Munchausen's syndrome presenting as rectal foreign body insertion may be identified and addressed more effectively using the approach described.

No MeSH data available.


Related in: MedlinePlus