Results
Overall, 14 patients presented with an ingested bottle cap between 01/2005 and 10/2014 were included in the study. The study population was exclusively male with an average (physical) age of 23.0 ± 4.2 years at the time of treatment with the eldest patient being 35.6 years and the youngest 18.3 years. Fraternity association was confirmed in 13 patients.
Upon first presentation, 12 patients reported a definitive ingestion of a bottlecap; in two patients there was no information available as to why the patients were admitted to the ER. All patients presented within 24 h after ingestion. Symptoms described were in all patients odyno-, dys- or aphagia, foreign body sensation and/or retrosternal pain. No patient was actually capable of properly swallowing. In nine patients, there was a positive anamnesis for alcohol consumption; in the other five cases, there were no information on previous alcohol consumption available in the patient files. Average blood alcohol concentration was 1.2 ± 0.8 g/l (Table (Table11).
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In all patients, there was radiographic proof by chest or neck X-ray of a bottlecap stuck in the esophagus. 10 (71.4%) were localized in the cranial third of the esophagus, 3 (21.4%) were localized in the middle third of the esophagus and 1 (7.1%) was localized in the caudal third of the esophagus (Figs. (Figs.1,1, ,2,2, ,3).3). Interestingly, in all imaging findings, the bottlecap has nearly the same alignment in space, flat parallel to the spine.
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7 (50%) of the patients were treated by the Department of Otorhinolaryngology and 7 (50%) were treated by the Gastroenterology Department. In all of the patients treated by rigid esophagoscopy, the bottlecap was successfully recovered upon the first attempt (7 of 7, 100%). It was removed by using an appropriate grasping forceps. In three of the seven patients treated by flexible endoscopy, the bottlecap was accidentally lodged into the stomach and subsequently removed by endoscopy within the same procedure in one case. Two of those cases (2 of 7, 28.6%) required a second day procedure. During flexible endoscopy the bottlecap was removed by appropriate grasping forceps in 5 cases, and using a mesh loop in 2 cases. In two cases, a “golden bottlecap” was reported or documented. 76.9% showed mucosal lesions after removal of the bottlecap. A control endoscopy after successful removal was performed in two of those cases. A nasogastric feeding tube has not been placed in any case.
All patients were discharged the same day or within the following 48 h after bottlecap removal. None of the patients were readmitted for the same or another bottlecap. In the further follow-up, a 22-year-old patient died 18 months after removal of the bottlecap in an alcohol-related incident.
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