title: Factitious vesicocutaneous fistula: an enigma in diagnosis and treatment.
abstract: A case report of a patient with a recurrent factitial vesicocutaneous and a tensor fasciae latae musculocutaneous flap were employed in reconstruction. Difficulty in diagnosis and treatment of this patient with factitial disease is emphasized. Excessive hospitalization and cost reflect these difficulties. A life-threatening disease was modified by planned reconstruction coordinated with antidepressant medication and psychotherapy. Treatment centered on avoiding insight and maintaining denial ASA defense mechanism. The transference of self-mutilation in the suprapubic region to the donor thigh was most important in this patient's survival.
mesh_terms: D000328:Adult; D005162:Factitious Disorders / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008306:Malingering / Q000523:psychology; D009723:Nurse-Patient Relations; D010817:Physician-Patient Relations; D011613:Psychotherapy; D012652:Self Mutilation / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D012871:Skin Diseases / Q000209:etiology* / Q000628:therapy; D001747:Urinary Bladder Fistula / Q000209:etiology* / Q000628:therapy