From our experience with chronic schizophrenic patients treated for acute intra-abdominal surgical disease, we present seven examples of this unique clinical condition. In all seven cases the decision to operate was preceded by considerable delay, owing to misleading medical history, patient behavior, and the lack of definitive signs of peritonitis. The intra-operative findings were unexpected, and in all cases the disease had reached an advanced stage. As chronic schizophrenic patients have a distorted perception of pain and seldom demonstrate a clinical picture commensurate with the disease, we advocate that a higher index of suspicion be assigned to these patients than to the average acutely ill patient.