# From Beer Pong to the OR: Management of Metallic Bottle Cap Foreign Body Ingestion

## TL;DR

This paper presents a case of a metallic bottle cap ingestion and discusses the management and risks associated with such rare foreign body ingestions.

## Contribution

The paper introduces a case study and clinical considerations for managing metallic bottle cap ingestion, a rare and underreported foreign body.

## Key findings

- A metallic bottle cap was successfully removed from the esophageal inlet using rigid esophagoscopy.
- Ingestion of sharp or irregular foreign bodies like bottle caps poses significant risks of mucosal injury or obstruction.
- Young, inebriated men are particularly vulnerable to such accidental ingestions.

## Abstract

Foreign body (FB) ingestion is a common presentation seen by otolaryngologists ranging from mild discomfort to life-threatening airway compromise. Although there is a plethora of research in the literature describing the best approach to managing common FB ingestion, there is a paucity of literature describing the safe extraction of more rare FBs, such as metallic bottle caps. This case highlights the successful management of a metallic beer bottle cap lodged in the esophageal inlet and discusses key clinical considerations for atypical FB ingestions. A 19-year-old man presented with acute throat pain, odynophagia, and globus sensation after accidentally ingesting a bottle cap during a drinking game. Radiographs revealed a radiopaque disc at the proximal esophageal inlet. The FB was successfully removed via rigid esophagoscopy without complication. While many ingested FBs are benign and pass spontaneously, sharp, serrated, or irregularly disc-shaped objects such as metallic bottle caps pose a significant risk of mucosal injury, perforation, pressure necrosis, or obstruction. Young, inebriated men engaging in high-risk drinking behaviors are particularly vulnerable to accidental FB ingestion, warranting heightened clinical suspicion by ENTs. This case emphasizes the importance of prompt diagnosis, imaging, and airway evaluation in managing hazardous foreign bodies. Raising awareness about atypical FB ingestions and developing standardized protocols for their evaluation and treatment may improve patient outcomes and prevent life-threatening complications.