[Laparotomy for acute abdomen in larvate depression].

35--40% of psychosomatic disturbances among depressive patients present as abdominal troubles. These are difficult to interpret in the case of larvate depression which manifests itself mainly in the somatic sphere. For the last twenty years, we have noticed an increased incidence of larvate depressions. As a result, patients are often inadequately treated or submitted to surgery. This report is about a 37-year-old female patient who was referred to us with the diagnosis of an acute abdomen. After extensive investigations we were able to rule out as well a mechanical as a reflectory ileus. Nevertheless, the rapid deterioration of her general condition, increasing peritonism and radiological evidence of ileus made us suspect a perforated ulcer with accompanying paralytic ileus and perform an exploratory laparotomy 24 h later. We were very surprised not to discover any abnormal findings at operation. The consultant psychiatrist eventually diagnosed a depression. Up to this date, we have not been able to discover any information about similar patients presenting with such an acute history, even in specialised psychiatric literature. Should one refer such patients with acute abdomen to the psychiatrist before operating?