[Case of a schizophrenic patient refusing emergent operation for ovarian torsion]

We report a case of a schizophrenic patient who rejected an emergent operation for ovarian torsion. A 48-year-old woman with ovarian torsion strictly turned down emergent surgery against the recommendation of her gynecologist, who could not communicate with her. In response to his request, a psychiatrist examined and diagnosed her as schizophrenia. Therefore, she was transferred to our hospital for management in closed wards. She was so paranoiac and self-defensive that we, the psychiatrist, the gynecologist, and the anesthesiologist, could not obtain informed consent for the operation from her. Because this was an emergent and life-threatening case, we attempted anesthesia and surgery with the consent of her mother and uncle. First, we took her not directly to the operating room but to ICU to relieve her anxiety and fear. Then, we intubated her under sedation and analgesia. Finally, we took her to the operating room and started the operation. Anesthesia was maintained with 1.5-2.0% sevoflurane and fentanyl (total 9 microg x kg(-1)). The operation was uneventful and she was retransferred to ICU with the tracheal tube in place. Next day she was extubated and left ICU. She was informed by her psychiatrist of the fact that the operation had been performed. Fortunately, her mental status and postoperative course was generally stable.