Accidental Ingestion of a Plastic Water Bottle Cap

A 78-year-old male was turned up to the emergency room with a 5-day history of vomiting, diffuse abdominal pain, and altered bowel habits. After physical examination, routine blood tests, chest, and abdominal radiographs, as well as an abdominal ultrasound had been contacted to examine his ongoing symptoms, a serious intestinal obstruction was revealed. Bowel obstruction is interrelated with his medical history, as he suffered from inoperable prostate cancer. A CT scan was performed to exclude an associated complication. A plastic, 3cm diameter, water bottle cap was in the ileum revealed with no evidence of perforation or collection. A colonoscopy by an experienced endoscopist failed to reach and retrieve the plastic water bottle cap. Finally, the plastic water bottle cap was removed through an enterotomy. Even if a careful history taking can give a clue for diagnosis, the cause of bowel obstruction could be a surprise.