Factitious Feculent Urine in an Adolescent Boy

PATIENTS who pretend to be sick and willingly undergo intrusive procedures, including surgery, have been seen at every medical center. The motives for this bizarre behavior often remain obscure, even when the patient is studied thoroughly. Reviews of chronic factitious illness or Munchausen's syndrome emphasize the heterogeneity of the underlying psychiatric conditions, but also indicate a marked preponderance of patients with personality disorders, and with histories of early childhood trauma and deprivation.¹,²In a study of factitious illness, Spiro identified three clinical types: sociopathic, hysterical, and schizophrenic.²Major factitious illness is rare in childhood and adolescence, although malingering with factitious fever³and other simulated symtoms can occur. We report the case of an adolescent boy who for nearly a year succeeded in simulating an enterovesicular fistula by contaminating his urine with feces and foodstuff, at times by retrograde injection of foreign substances into his bladder. The case