The chest X-ray showed a metal rod running straight down the middle of a woman’s body, from her neck into the middle of her chest. It measured 22.5 centimeters, nearly 9 inches, from end to end.
It was a kitchen spatula. The 34-year-old, who has anxiety and bulimia nervosa, had swallowed it during a purging episode. When she reached the emergency department, her vital signs were stable, but she could not swallow her own saliva and was sitting in a tripod position, leaning forward on her hands. Otolaryngologists at Thomas Jefferson University in Philadelphia described how they removed it, and why they started with her airway, in Clinical Case Reports, published July 31, 2026.
The image is startling. The case behind it is a reminder of the physical dangers that can accompany an eating disorder.
What Doctors Saw Before the Procedure
The woman told clinicians she had a long history of restricting food and purging, and she had been hospitalized for psychiatric care about 10 years earlier. On examination, the tip of the spatula was visible at the back of her throat.
The radiology report described a metallic object 22.5 centimeters long and 8 millimeters wide, extending from the level of the fourth neck vertebra to the eighth vertebra of the mid-back. A flexible scope passed through the nose showed the flat end of the spatula lodged just behind the lower voice box, at the entrance to the esophagus. Her airway itself remained wide open.
Her blood work showed an elevated white blood cell count and a low phosphate level.
Why the Airway Came First
Emergency endoscopic removal, using a scope passed through the mouth, is commonly the first approach for a large swallowed object that is causing symptoms, the authors write. When an object completely blocks the esophagus, as in this case, removal is recommended within two hours and no later than six.
This object, however, sat right next to the airway. Rather than putting her to sleep first, the team took her to the operating room for an awake fiberoptic intubation. In that approach, a breathing tube is guided into the windpipe with a thin, flexible camera while the patient is still awake and breathing, so the airway is secured before sedation. With her airway protected, the team used video laryngoscopy, a camera-equipped blade that gives a magnified view of the throat, to guide retrieval of the spatula with grasping forceps.
A scope check afterward found no tears, scrapes, or perforations in her esophagus or stomach, and the breathing tube was removed without problems. The approach avoided more invasive surgery, the authors wrote. She was observed closely on the first day after the procedure and was eating a soft, bite-sized diet before discharge.
People with bulimia face higher risks during procedures, the authors add, citing a review of the medical complications of bulimia. Repeated vomiting can injure the lining of the throat and esophagus over time, stomach emptying can be delayed, and nutritional deficiencies are possible.
A Rare Injury Tied to a Serious Illness
Up to 80% of smaller swallowed objects pass on their own, the report notes. Large or rigid ones are different and may need to be removed.
In adults, swallowing foreign objects is often associated with psychiatric illness, cognitive impairment, or substance use disorders, the authors write, citing a systematic review of deliberate foreign body ingestion. Earlier reports in patients with bulimia have described accidental swallowing of cutlery and toothbrushes, but reports involving large, rigid objects like a spatula are rare.
Bulimia affects about 1% of U.S. adults at some point in their lives, according to National Institute of Mental Health figures drawn from a national survey conducted between 2001 and 2003. In a given year, the figure was 0.3%, and it was five times higher among women than men. In that survey, 78% of adults with past-year bulimia reported some impairment in daily life, and 94.5% of those with bulimia met criteria for at least one other core mental disorder.
The authors stress that the procedure was only part of her care. A psychiatry team saw her after surgery and discussed the risks of malnutrition and refeeding syndrome, a dangerous shift in body chemistry that can occur when nutrition is restarted. She declined inpatient eating disorder treatment but arranged outpatient care and follow-up. Because the risk of recurrence is high, the authors write, psychiatric input is essential.
What One Case Can and Cannot Show
This report describes a single patient at a single academic center. It cannot say how often such injuries occur, and the airway strategy depended on having the right specialists and equipment available. The authors declared no conflicts of interest, the university’s institutional review board deemed the report exempt, and the patient gave written consent for publication.
Choking or trouble breathing after swallowing an object is an emergency that calls for 911. Anyone who has swallowed something sharp or large, or something that feels stuck in the throat or chest, should get medical care promptly rather than waiting for it to pass.
People struggling with bulimia or another eating disorder can find support. The National Association of Anorexia Nervosa and Associated Disorders runs a free helpline at 888-375-7767 that offers support and treatment referrals. Anyone in crisis can call or text 988, and anyone in immediate danger should call 911.
Key Questions Answered
What happened to the woman?
A 34-year-old with bulimia nervosa and anxiety swallowed a kitchen spatula during a purging episode. Imaging showed it reaching from her neck into her chest.
How did doctors remove it?
They first secured her airway with an awake fiberoptic intubation, then used video laryngoscopy to guide retrieval with forceps, avoiding more invasive surgery.
How did she recover?
A scope check found no injury to her esophagus or stomach. She was observed closely the day after the procedure, was eating a soft, bite-sized diet before discharge, and arranged outpatient eating disorder care.
How common is this kind of injury?
Swallowing large, rigid objects is rare, and a single case report cannot estimate how often it happens.
Where can people with an eating disorder find help?
The ANAD helpline at 888-375-7767 offers free support and treatment referrals. Anyone in crisis can call or text 988, and anyone in immediate danger should call 911.
