A 53-year-old man in Uganda shook a reused mineral water bottle containing homemade juice, building up pressure inside. He tried to open it with his teeth, and the cap came loose into his mouth. He swallowed it.
About three hours later, he went to a hospital with throat pain, pain when swallowing, trouble getting anything down, drooling, and the sensation that something was stuck. X-rays of his neck did not show the cap.
Ear, nose, and throat specialists at Kampala International University reported the case on Oct. 8 in the International Medical Case Reports Journal. The team described how they found and removed it without CT imaging or flexible endoscopy.
An X-Ray That Showed Nothing
Plastic often does not show up well on plain X-rays, and the cap was no exception. The neck films still showed that his airway was clear.
His symptoms also helped. He had drooling, trouble swallowing, and the feeling that something was stuck, which pointed to the upper esophagus. He had no choking, wheezing, or breathing distress, which would suggest an object was in the airway.
In many hospitals, the next step would be a CT scan. That was not an option. CT was not available locally, and the team judged that transferring him could delay treatment.
Removing It Without an Endoscope
Guidelines generally favor prompt endoscopy for objects stuck in the esophagus. But flexible endoscopy under local anesthesia was not available either.
So the team took him to the operating room under general anesthesia and looked directly with a Macintosh laryngoscope, the standard tool for viewing the throat when placing a breathing tube. They found the cap lodged at the cricopharyngeal opening, the muscular entrance to the esophagus, and removed it with Magill forceps, long curved forceps designed for the throat.
The lining where it had been stuck was only mildly reddened, with no tear or cut. Treating him on site also spared him the delay of transfer to a better-equipped hospital. He went home on acid-reducing medication and pain relievers with instructions to eat soft foods. Five days later, he had no symptoms. He also agreed to stop opening bottles with his teeth.
The authors acknowledged the limits of their report: no CT, no flexible endoscopy, short follow-up, and a single patient whose experience may not apply to others.
The Same Habit, the Same Result
Opening bottles with teeth has sent caps down other throats. In 2019, a 7-year-old from Hyattsville, Maryland, used his teeth at summer camp to open a plastic water bottle he could not open by hand, and pressure launched the clear cap into his mouth and down his esophagus, according to WJLA. Multiple X-rays did not reveal it. A contrast swallow did, and a pediatric surgeon at Children’s National Hospital captured it with a net-like snare passed through a flexible endoscope.
Metal caps carry their own risk because of their crimped edges. A 22-year-old in Poland swallowed a metal cap after opening a cider bottle with his teeth, and doctors removed it endoscopically, according to a 2017 report in Endoscopy. In Turkey, a 16-year-old boy said a carbonated drink cap blew off and down his throat as he tried to open the bottle with his teeth; doctors pulled it from the middle of his esophagus with a netted snare.
Alcohol was a common thread in adult cases. In a 2025 Cureus report by authors affiliated with UCLA, a 55-year-old man swallowed a metal bottle cap after drinking heavily at a wedding dinner. Initial endoscopic attempts failed because it was lodged in the esophageal wall, and gastroenterologists and ear, nose, and throat specialists removed it together under general anesthesia. A 2025 report in the journal Medicine described a 49-year-old man with 20 years of daily alcohol and tobacco use who swallowed a 2.5-centimeter beer bottle cap and felt nothing for about three hours. Flexible instruments could not remove it, and doctors needed a rigid scope under anesthesia.
The Ugandan authors cited estimates that about 10% to 20% of swallowed objects need endoscopic removal and fewer than 1% need surgery.
Teeth Are Not Bottle Openers
The Ugandan case adds a specific warning about pressure. Shaking a sealed bottle can turn the cap into a projectile the moment it loosens, and using the teeth puts it right at the entrance to the throat.
The authors’ prevention advice is simple: do not open bottles with your teeth. Common-sense steps help too, such as opening shaken or carbonated drinks slowly by hand, pointing them away from the face and using an opener when a cap will not budge.
Anyone who swallows a cap and develops throat or chest pain, trouble swallowing, drooling, or a feeling of something stuck should seek emergency care, even if an X-ray looks normal. Trouble breathing, choking, or wheezing calls for 911.
Key Questions Answered
What happened to the man?
He shook a reused bottle of homemade juice, then tried opening it with his teeth. The cap came loose into his mouth, and he swallowed it.
Where did the cap end up?
At the cricopharyngeal opening, the muscular entrance to the esophagus.
Why didn’t the X-ray show it?
Plastic often does not appear on plain X-rays. The films did confirm his airway was clear.
How was it removed?
Under general anesthesia, using a laryngoscope and long curved forceps, because CT and flexible endoscopy were not available.
Has this happened to others?
Yes. A Maryland boy, a Turkish teen, and a Polish man all swallowed caps after opening bottles with their teeth, and adults who had been drinking have swallowed metal caps.
How can people avoid this?
Do not open bottles with your teeth, and open shaken or carbonated bottles slowly by hand, pointing away from your face.
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