Self-induced Vomiting as a Presentation of Abdominal Mass

In children and adolescents, the symptom of vomiting may be associated with a myriad of organic causes, including infections, toxic ingestions, migraine, medication side effect, anatomic obstruction, pregnancy, and increased intracranial pressure.¹ Vomiting and other gastrointestinal symptoms may be prominent in psychiatric illnesses as well. They are particularly associated with separation anxiety disorder, panic disorder, somatization disorder, and factitious disorder.^2,3 Self-induced vomiting is known to be a frequent method of purging in patients with bulimia nervosa.⁴ In addition, the practice of self-induced emesis may be present in individuals who do not otherwise meet criteria for diagnosis of an eating disorder. A population-based study of high school girls found that 8% had induced vomiting within the year before the survey as a weight control measure.⁵ Organic causes have been reported in cases of “psychogenic vomiting.”^6,7 However, we believe that this is the first report of a pelvic malignant neoplasm being heralded by self-induced vomiting.