The n e w e ng l a n d j o u r na l of m e dic i n e

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Unexpected Swallowing of a Knife

A B

A 
30-year-old woman with a history of bulimia presented to the Aida Venado, M.D.
emergency department after swallowing a knife. She inserted the knife into Sarah Prebil, M.D.
the posterior oropharynx to demonstrate to her companions that she no Emory University School of Medicine
longer had a gag reflex. When she unexpectedly laughed, the knife migrated into Atlanta, GA
her esophagus, causing chest discomfort and hematemesis. Anteroposterior chest
and abdominal radiographs (Panels A and B) revealed a knife within the distal esoph-
agus and proximal stomach, without evidence of pneumothorax, pneumomediasti-
num, or pneumoperitoneum. A rigid esophagogastroduodenoscopy was performed
to remove the knife. The esophagus and stomach otherwise appeared grossly normal.
A swallowing study showed no extravasation of contrast material from the upper
gastrointestinal tract, and the patient subsequently resumed eating without compli-
cations. Her husband later disclosed that 4 years earlier she had swallowed a knife
that required surgical removal with exploratory laparotomy. Consultation with a
psychiatrist was recommended, and the patient was later transferred to an inpatient
psychiatric unit.
DOI: 10.1056/NEJMicm1008826
Copyright © 2012 Massachusetts Medical Society.

n engl j med 367;5  nejm.org  august 2, 2012 451

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