AB029. SOH25_AB_400. First presentation of psychosis, mimicking an acute appendicitis in an adolescent male: a novel case

Background: Acute appendicitis is the most common cause for acute abdominal surgery in paediatric patients, and one of the most common causes for emergency abdominal surgery worldwide. A child exhibiting psychosis presents a complex clinical challenge, creating difficulties for clinicians, healthcare services, the family, and the affected child. Abdominal pain as a symptom of psychosis, whilst uncommon has been reported in the literature.

Methods: We report the case of a 15-year-old boy presenting with severe abdominal pain and tenderness who underwent diagnostic laparoscopy and appendicectomy with inconclusive histopathology. He required further significant work-up for ongoing pain and behavioural disturbance.

Results: Post operatively, due to ongoing episodes of acute behavioural disturbance, attributed to pain; associated with aggression, catatonia and suicidal-ideation he required multidisciplinary input. He was transferred to a tertiary paediatric hospital, and a diagnosis of psychosis was made.

Conclusions: The purpose of this presentation is to highlight the difficulties posed in dealing with distressed paediatric patients reporting severe pain, in the absence of an identifiable organic cause. Furthermore, it shows importance of lateral thinking of surgical teams, considered investigative processes regarding differential diagnoses and the value in collaboration care.

Keywords: Abdominal pain; psychosis; adolescence; appendicitis; behavioural disturbance