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

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.