25.1.23

A 45 years old female had been posted for surgery for piles and a possible fissure too. At operation, the patient turned out to be very uncooperative, moving restlessly and talking incessantly and loudly. The anaesthetist had to use propofol to the spinal anesthesia to calm her down. An examination under anesthesia revealed no piles and no fissure, albeit a small perianal posterior skin tag was present. This was just excised. The anesthetist during the procedure had revealed her history of 4 previous surgeries for similar complaints. Munchausen syndrome was suggested as the possible diagnosis and was agreed to in the end with the treating physician.

The other case, a 45 years old male, was posted for appendicectomy. At operation, on palpation under anesthesia, a firm fixed mass was palpable. Again during surgery, the anesthetist gave the history! The patient had had pain for 4 months, was an opium addict and continued to neglect his symptoms. The incision had to be extended (RM), and a retrocecal chronic abscess and appendix were found with great difficulty. The pus was drained and the cavity washed clean after removing the appendix.