PIG Meeting: 1st July 2021

37-year-old lady for elective repair of an epigastric hernia

Background

• Significant mental health history with multiple inpatient admissions – voluntary and involuntary
• Polysubstance abuse
• Multiple previous hernia repairs

Issues

• On day of surgery, patient thought she was being admitted for a caesarean section
• Support person confirmed this, and alleged patient had been using amphetamines recently
• Procedural anaesthetist reviewed patient who reiterated she was pregnant, and it was her due date.
• Patient thought that the investigations for the hernia were for obstetric purposes
• Beta-HCG negative
• Postponed in conjunction with surgical team
• Psych liaison contacted and recommended admission, but patient absconded post review
• Outpatient welfare visit and psychiatry follow-up organised by Psych-Liaison nurse

Discussion

Could the acute Psychiatric deterioration have been identified preoperatively?

• Unlikely, may have been very acute. Alleged recent excessive amphetamine use.
• Difficult via phone consult

Management of Patient

• Appropriate care provided to patient
• Unable to consent at time of elective procedure
• Psych Liaison services available at JHH and very helpful with this case