FACTITIOUS GASTROINTESTINAL-BLEEDING IN 3 SCHOOL-AGE GIRLS

Three female patients aged 9, 13 and 14 years, respectively, seen by t he authors over a 1-year period presented with the complaint of recurr ent hematemesis (2 patients) or melena (1 patient). The (presumed) ble eding episodes had only been seen by the respective patient and one pa rent (the mother in two cases and the father in one). In two cases, th e other parent was antagonistic with the reported situation. A clear s ymbiosis had been forged between the index case and the allied parent. Two patients had previously been seen in several hospitals and had un dergone various diagnostic tests, including esophagogastrodudodenoscop ies, all of which had proved normal. Two girls had attempted suicide. Two of the mothers had a depressive disorder. Re-evaluation of the pat ients by the authors again ruled out any cause for the presumed bleedi ng 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 psychiat ric profiles of the patients and their families is critical for practi tioners in order to recognize factitious illness whenever a patient wi th a history of gastrointestinal bleeding presents with incongruous or illogical medical history and clinical findings.