%0 Journal Article
%T Munchausen syndrome in the emergency department mostly difficult, sometimes easy to diagnose: a case report and review of the literature
%A Rinaldo Lauwers
%A Nele Van De Winkel
%A Nathalie Vanderbruggen
%A Ives Hubloue
%J World Journal of Emergency Surgery
%D 2009
%I BioMed Central
%R 10.1186/1749-7922-4-38
%X This trained nurse presented at our emergency department (ED) complaining of abdominal pain. Interviewed by the medical trainee, she immediately confessed having put a knitting needle into her urethra four days earlier. She was not able to remove it anymore because it was beyond her reach. Abdominal X-ray confirmed the presence of the needle and a median laparotomy was performed to remove it. The diagnosis of Munchausen syndrome seemed immediately obvious in this case.Doctors working at the emergency department often encounter patients who exaggerate, feign or aggravate their symptoms in order to get more attention and be treated more rapidly. In Munchausen syndrome, a particular form of factitious disorders, symptoms of illness or injury are intentionally produced for psychological reasons in order to be hospitalised and even to submit her to invasive interventions [1]. Many psychiatric disorders are seen at the ED, from depressive patients over psychosomatic complaints to severe psychiatric disorders as there are Munchausen syndrome, conversion disorders, hypochondriasis, malignering and somatisation disorders. The lack of medical documentation to substantiate the self-reported medical history is notable and good physical examination (scars, little haemorrhages) is indispensable and can help to diagnose more rapidly Munchausen syndrome which isn't easy in the ED.A 40-year-old female presented at the ED triage desk with abdominal pain without any further complaints. Interviewed by a medical student she admitted having put a knitting needle into her urethra repetitively for the last 4 days and that now the needle was beyond her reach. Further interrogation was not contributively and except for abdominal tenderness physical examination was normal with initial vital signs of BP 124/76 mmHg, heart rate 91 bpm, a respiratory rate of 10 breaths per min, and temperature of 36.8ˇăC. Complementary investigations were performed, the CBC revealed hematocrit 31% (36.4 - 43.9),
%U http://www.wjes.org/content/4/1/38