The New England Journal of Medicine

A 30-year-old woman with a history of bulimia was trying to demonstrate to her friends that she no longer had a gag reflex -- and then she swallowed the knife she was using to demonstrate.

Playing with a knife is risky, as one young woman learned the hard way.

A 30-year-old woman who suffered from bulimia was showing off for her sister. To prove that she no longer had a gag reflex, she stuck a table knife to the back of her throat and unexpectedly laughed during her demonstration.

The giggles accidentally sent the knife sliding down her throat, and the result was no laughing matter: She swallowed the knife and soon started throwing up blood and having chest pain.

Fortunately for her, she chose a table knife, not the sharpest knife in the drawer -- but even so, it quickly landed her in the emergency room. In a case reported in this week's New England Journal of Medicine, X-rays revealed the knife was stuck in her esophagus and the upper part of her stomach.

She needed a "rigid esophagogastroduodenoscopy" to remove the knife. This medical procedure involves inserting a tube with a camera into the throat and advancing it down to the esophagus.

"This allows the removal of the knife under direct vision using forceps as well as inspecting the GI tract," says Dr. Aida Venado, who, along with Dr. Sarah Prebil, authored the case study and treated the woman when both were internal medicine residents at Emory University School of Medicine in Atlanta.

Doctors found no immediately visible cuts from the knife in her GI tract. But since these tiny tears may be hard to spot, they did a second test in which they gave the woman a special liquid to drink to see if there were any leaks in her digestive system. None were found.

"The patient was very fortunate to have a good outcome," says Venado. The risks of swallowing a "foreign body" as the knife is referred to in medical circles, include perforating the GI or respiratory tract, injury to major blood vessels, and a serious infection, explains Venado.

"It definitely helped that the object was removed promptly," she says. 

But sadly, this wasn't the first time the woman had swallowed a knife. Her husband told doctors that his wife had also swallowed a knife four years earlier, which had required surgery to remove it.

It's unclear what circumstances had brought about the earlier episode, yet she did have a surgical scar in her abdomen as proof of the incident.

After a few days in the hospital following the latest knife swallowing episode, doctors transferred the woman to the inpatient psychiatric unit for help in treating her bulimia.

Dr. Venado says she doesn't see too many patients who have swallowed unusual objects. But more common culprits are meat bones, coins, batteries, and this time of year, wire bristles from grill-cleaning brushes.

Accidentally or intentionally swallowing these foreign objects can be a life-threatening emergency, where careful removal may be needed, Venado suggests. 

Although this woman's story turned out OK, it might have been helpful for her to have a normally functioning gag reflex in response to placing a knife down her throat.

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