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Woman laughs, accidentally swallows knife

August 03, 2012|By Rosie Mestel | Los Angeles Times
  • A case story in the New England Journal of Medicine described how a woman came to swallow a knife.
A case story in the New England Journal of Medicine described how a woman… (New England Journal of Medicine )

"Unexpected Swallowing of a Knife" -- that's a grabbier title than most ones you see in medical journals. 

The short item, a clinical image in this week's New England Journal of Medicine, explains that a 30-year-old woman with a history of bulimia had been bragging to friends that she no longer had a gag reflex. She put the knife into her mouth and then laughed -- at which point she swallowed the knife.

Here are the X-rays. The knife was removed -- no physical damage done. The woman, it later transpired, had swallowed a knife once before. She was referred to a psychiatrist.

The gut is more resilient than one might imagine: I once wrote an article about a man who ate an entire four-seater Cessna, bit by bit; he had started out on glass and bicycles, and moved up. (Read about Michel Lotito.) The same article also featured a British legend, Peter Dowdeswell (who once claimed many of the competitive eating titles in the Guinness World Records, until they were removed from its pages) -- his accomplishments include 100 yards of spaghetti in 21.7 seconds and 113 doughnuts in eight minutes, as well as a few edgier ones involving swallowing glass or razor blades. DO NOT TRY THIS!

Though in no way approving of such antics, gastroenterologists commented that they'd seen all kinds of  foreign bodies ingested by patients with surprisingly slight medical fallout.

A 2010 report from Rhode Island Hospital listed a buffet of items people had ingested before seeking help at the facility: "pens (whole or in parts), followed by batteries, knives, razor blades, other metal objects, pencils, toothbrushes, spoons and coins. Despite the number of sharp objects ingested, there were no deaths or perforations reported in any of the cases."

And this article notes that "after reaching the stomach, a foreign body has greater than a 90% chance of passage" all the way through the gut to the other end. (It shows an image of a screw, and describes how the squeezing of the intestine would move the head of the screw along and drag the pointy end behind it, which would serve to minimize damage, you would think.) 

However, the article also notes that there are about 1,500 deaths a year from ingesting foreign bodies. And this review article of competitive speed-eaters concludes that "successful speed eaters expand the stomach to form an enormous flaccid sac capable of accommodating huge amounts of food. We speculate that professional speed-eaters eventually may develop morbid obesity, profound gastroparesis, intractable nausea and vomiting, and even the need for a gastrectomy." (Glory, no guts, in other words.)

Why do people do it?  Children do it because ... well, they're children. (Why wouldn't you put a crayon up your nose or a battery in your mouth?) Competitive eaters do it for the thrill of winning, we guess. In other adult cases, not surprisingly -- aside from accidental swallowing of toothpicks or dentures -- the patients usually are found to have other psychiatric problems.

Removal of the foreign objects is medically costly, the Rhode Island Hospital study reported, and the people prone to such activities are very hard to treat.

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