Reprinted from Eating Disorders Review
July/August 2008 Volume 19, Number 4
©2008 Gürze Books
Patients with bulimia nervosa (BN) are notoriously secretive, which makes diagnosis a challenge. When a young adult accidentally ingests a foreign body, this may be a clue to a larger problem, like BN. Two case studies demonstrate this relationship.
In such cases, a thorough and detailed history can be a lifesaver, according to three British otolaryngologists. A 19-year-old woman was examined in their department after she accidentally swallowed a teaspoon. When they questioned her in detail, she admitted binge-eating and purging. She blamed this behavior on problems with a stressful relationship with her partner (J Laryngol Otol 2008; 28:1).
When the physicians checked her medical history, they discovered that she had been admitted earlier for accidental ingestion of a plastic spoon, which had been removed by esophagogastroduodenoscopy. During the postoperative period, the physicians learned even more when the patient admitted that she had undetected bulimia and anorexia nervosa for years. She was discharged home after appropriate psychiatric counseling, and follow-up was arranged.
In another case, a patient was admitted for complete dysphasia resulting from swallowing a plastic fork, which had lodged in the hypopharynx (J Accid Emerg Med 1998; 15:332). A thorough history revealed that the patient had been trying to induce vomiting. According to the authors, the history revealed that, like the first patient, this patient had a long history of undetected bulimia.