Esophageal bottle cap impaction in adult: A case report.

RATIONALE: Adult esophageal foreign-body impaction is typically food-related, whereas impaction of large non-food objects is rare and usually associated with structural abnormalities or altered mental status. We present an unusual case of an alert adult with chronic ethanol-nicotine co-use who remained asymptomatic for 3 hours after ingesting a beer bottle cap, highlighting the potential for substance-related impairment of protective pharyngeal reflexes.

PATIENT CONCERNS: A 49-year-old man with a 20-year history of daily alcohol and tobacco use developed acute pharyngeal pain 3 hours after attending a banquet. He denied any psychiatric history or prior dysphagia.

DIAGNOSES: Digital radiography and computed tomography revealed a 2.5-cm radiopaque foreign body at the thoracic inlet, 18 cm from the incisors, consistent with a bottle cap. No underlying structural lesion was identified.

INTERVENTIONS: Flexible endoscopic retrieval failed due to persistent upper-esophageal sphincter tone. Rigid esophagoscopy under general anesthesia was successfully performed, enabling en bloc extraction of the bottle cap with minimal mucosal abrasion.

OUTCOMES: Post-extraction endoscopy showed only superficial mucosal erosions without perforation or stricture. The patient was discharged uneventfully and remained asymptomatic at 3-month follow-up.

LESSONS: Chronic ethanol-nicotine co-use may blunt pharyngeal sensitivity and delay symptom onset, increasing the risk of large non-food esophageal foreign-body impaction. Clinicians should maintain a high index of suspicion for foreign-body impaction in substance-using adults, even in the absence of immediate symptoms or structural disease.