| Summary: | Introduction: Aorto-esophageal fistula (AEF) is a rare complication of foreign body ingestion with a mortality of 40%–60%. Most ingested foreign bodies pass spontaneously, but some can lodge in the esophagus and cause severe complications. Diagnostic approaches include chest and abdominal radiography, esophagogastroduodenoscopy, and computed tomography-angiography. Case presentation: A 2-year-old boy presented with a 5-month history of progressive dysphagia that began with solid food and progressed to liquids, associated with vomiting and weight loss. An upper gastrointestinal contrast study suggested proximal and mid-esophageal dilatation, and a narrowed lumen 14 cm from the incisors. Multiple attempts to insert the nasogastric tube failed. He underwent esophagogastroduodenoscopy and balloon esophageal dilation. He recovered smoothly after dilatation and was discharged home. Three additional dilatations were performed successfully. Four weeks later, he presented to the emergency department with hematemesis, requiring resuscitation and blood transfusions. Emergent chest computed tomography with contrast suggested an AEF. Median sternotomy was performed. The AEF was divided, and the aortic end was closed with multiple sutures. A missed plastic foreign body measuring 1 cm × 1 cm was embedded in the esophageal wall. A piece of pericardium was placed between the aorta and the esophagus. An esophagogram was done 10 days later and showed no stricture, leak, or re-fistula. Conclusion: A foreign body should be included in the differential diagnosis of patients with esophageal strictures of unknown origin and patients with AEF.
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