Acute psychosis and hernia repair

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

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