Purpose: The aim of this study was to present the clinical findings and treatment of pen cap inhalation with emphasis on the importance of managing aspirated foreign bodies by rigid bronchoscopy. Methods and Patients: Of 1280 patients with foreign body inhalation treated from 1997 to 2007, 34 (2.65%) were because of pen cap inhalation. Medical records of these 34 patients were retrospectively reviewed and analyzed for age, sex, symptoms, location of pen cap, treatment, complications, and outcomes. Results: Of the 34 children with pen cap inhalation, 22 (64.7%) were boys and 12 (35.3%) were girls. They ranged in age from 6 to 14 years, pen caps were most frequently found in the right main stein bronchus (26 cases, 76.4%). A history of an episode of foreign body inhalation (34 cases, 100%) and acute cough (28 cases, 82.3%) were the most common presenting findings. All inhaled pen caps were successfully removed by reverse grasping forceps during rigid bronchoscopy. Tracheotomy, thoracotomy, and bronchotomy were not performed in any patients. There were no severe complications or deaths. Conclusions: Pen cap inhalation mostly occurs in school-aged children. Patients usually can depict a clear history of pen cap inhalation, which is vital to early diagnosis. Inhaled pen caps can be removed safety by rigid bronchoscopy under general anesthesia combined with topical anesthesia. Open surgical techniques such as tracheotomy, thoracotomy, and bronchotomy can be avoided in most cases. More attention to programs of prevention, public and parent education, and awareness is needed to reduce the incidence of pen cap inhalation. (c) 2009 Elsevier Inc. All rights reserved.