Bottle caps are an unusual cause of foreign body obstruction. Although there have been 4 cases of bottle cap ingestion reported in the literature, there have been no cases of bottle caps causing gastric ulcers. We report a 41-year-old man who accidentally swallowed a metallic bottle cap from a soda bottle. At the time, he was driving a truck and was playing with the bottle cap in his mouth. Abdominal X-ray confirmed the presence of the bottle cap in his stomach and he was treated conservatively. However, he developed multiple daily episodes of severe epigastric pain associated with several episodes of hematemesis per week. There was no melena or hematochezia. After 4 weeks, a Barium swallow revealed an ulcer in the distal antrum and a bottle cap in the stomach. Past medical history included gastroesophageal reflux disease and an appendectomy. There was no history of previous foreign body ingestion, peptic ulcer disease, or other gastrointestinal/liver diseases. There were no previous psychiatric illnesses. He was not on any ASA or NSAIDs. Physical examination was unremarkable for any abdominal tenderness, hepatosplenomegaly, or masses. Gastroscopy revealed a bottle cap in the distal antrum that was slightly adherent to the gastric wall. A rat tooth forceps failed to grasp the bottle cap. A stent retrieval forceps easily dislodged the bottle cap. A healing ulcer was present at the pyloric channel. The bottle cap was carefully withdrawn from the stomach. There was some resistance passing the scope through the gastroesophageal junction but the bottle cap remained firmly grasped by the forceps. There was considerable resistance at the cricopharynx but with a 90-degree turn of the gastroscope, the bottle cap was passed into the oral cavity and recovered. It measured 2.7 cm in diameter. Antral biopsies for Helicobacter pylori were negative. The patient recovered and had no further symptoms at 3-month follow-up. Conclusions: Foreign bodies such as bottle caps that are greater than 2.5 cm in diameter are unlikely to pass the pylorus and endoscopic retrieval may be necessary. Stent retrieval forceps effectively grasp metal objects such as bottle caps. The area of greatest resistance is the cricopharynx and reorientation in a different plane may facilitate removal. This patient's pyloric channel ulcer was likely due to trauma from the bottle cap given that he was H. pylori negative and not on NSAIDs.

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