Schizoaffective disorder is categorized by major mood episodes and symptoms of
schizophrenia that include disorganized speech, delusions,
paranoia, and
hallucinations. It is associated with risk factors, including a history of abuse and cannabis use, and patients are typically diagnosed in adolescence and young adulthood. In this case report, we describe the unusual case of a 39-year-old male patient with undiagnosed
schizoaffective disorder who self-eviscerated his intestines during an episode of
psychosis. He received an emergent exploratory
laparotomy with a partial
colectomy. After medical stabilization and reorientation, the patient recalled a 10-year history of
paranoia associated with significant cannabis use, despite otherwise functioning appropriately in society. During a two-week hospital course, his
paranoia and
hallucinations were remitted on
olanzapine and
valproic acid. In addition to discussing his presentation and recollection of the incident, we also discuss similar cases of
self-mutilation in nonsuicidal patients and the relationship between cannabis use and
schizophrenia spectrum disorders.