In the past 10 years, I have experienced 2 cases of young adult females demonstrating what I considered weird post operative behaviors outside the realm of psychosis.
Case 1: Dateline 2007. A young adult female presented with features of inactive CSOM and persistent annoying ipsilateral tinnitus. Clinical and audiometric analysis showed moderate conductive hearing loss and a 75% pas tensa perforation. The handle of malleus was eroded. So a type 3 tympanoplasty was planned and carried out. Now as was explained to her pre operative, her follow up would entail review on day 3, day 7(for removal of sutures) and day 10(for first graft inspection). However following discharge home on day 3, she absconded (with aural packs in situ!) only to re-appear on day 20 post op complaining of persistent tinnitus and requesting for referral to 'go abroad' for further care. Examination revealed the aural packs were already removed (by who?). Apparently she had travelled 800 km (Abuja to Lagos) to go and consult another facility where she claimed the sutures and packs were removed!!! Apparently she also had attempted securing entry visa to the particular country to meet with her 'fiancé' and failed prior to coming for surgery, and was planning to use the surgery and the report as a means of authenticating her visa claim. Lesson learned: do not carry out tympanoplasty on anyone whose main worry for coming to surgery is tinnitus
Case 2: Dateline 2014. A young female with left parotid tumor of 8 months duration was referred by her sister to a private facility for review and surgery. Clinical examination showed a firm, smooth, non-tender left tail-of-parotid tumor measuring 4x5 cm, with limited mobility, no skin involvement and intact facial nerve. She had no palpable neck nodes associated. Prior to referral she had FNAC with inconclusive cytology report. U.S. Scan confirmed tail of parotid lesion. She was clinically diagnosed as Pleomorphic adenoma. She has superficial Parotidectomy and as was the practice at that setting, she was handed the specimen for onward transfer to Histopathology at nearby facility. Her follow up after was tied to her collecting and presenting the histology report. However she absconded and represented 4 months later with a pea-size mobile nodular swelling inferior to site of previous surgery, and hyperpigmented overlying skin. Apparently she had gone to collect her histology report, read it and referred herself for oncology treatment. She already had chemo-radiation and only noticed the nodular swelling after completion of therapy, all without the knowledge of the primary surgeon!!! A repeat biopsy with neck dissection was suggested. She again absconded, went to a third facility where the excision of nodular swelling was done. She presented again to the primary surgeon 12 months after with cutaneous involvement. At this stage, all that the primary surgeon could do was referral for palliative oncology care.
It is, up to the present, perplexing why such bizzare postoperative behaviors could manifested in otherwise sane, young and educated women.
Observe the nodular swelling just inferior to hyperpigmented (post XRT) skin area. This was at second presentation after initial default to postop visit.
Further Reading
1. Post operative confusion - Guide to management. https://mpatkin.org/surgery_clinical/post_op_confusion.htm
2. Confused about postoperative confusion.
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