Background: Aorto-oesophageal fistula (AEF) is an abnormal connection between the oesophagus and the aorta. This is the first reported case in Australia demonstrating oesophageal perforation by a chicken bone. Case: A 65-year-old woman presented with haematemesis, dysphagia, odynophagia, chest and back pain after ingesting a sandwich. CT showed a 5cm bone lodged in the mid-oesophagus and abutting the aortic arch. During endoscopy, brisk pulsatile bleeding occurred, confirming AEF. Urgent thoracic endovascular aortic repair (TEVAR) with planned endoscopic removal of the bone was performed. Endoluminal stent-graft was positioned immediately distal to the left subclavian artery and in the proximal descending thoracic aorta. It was deployed when bleeding began and achieved immediate haemostasis. The bone was then removed endoscopically. Repeat endoscopy showed opposing linear tears which were clipped. A nasojejunal tube was placed. She received broad-spectrum antibiotics for mediastinitis and graft contamination. She has remained nil-by-mouth awaiting interval CT in 1 week. Discussion: Foreign-body induced AEF is extremely uncommon. Early symptoms may mimic benign oesophageal disease. There is no case with AEF caused by foreign body survived without surgery. The post operative mortality is high mainly due to mediastinitis. Early antibiotic treatment is crucial. Conclusion: Chicken bone-induced AEF is life-threatening. Early CT, swift diagnosis, and a coordinated endovascular–endoscopic approach can be lifesaving. Reference: 1. Zhang X, Liu J, Li J, Hu J, Yu F, Li S, Yang X. Diagnosis and treatment of 32 cases with aortoesophageal fistula due to esophageal foreign body. The Laryngoscope. 2011 Feb;121(2):267-72. 2. Shen JY, Zhang HW, Fan KJ, Liao H, Zhang EY, Hu J. Aortoesophageal fistula and arch pseudoaneurysm after removing of a swallowed chicken bone: a case report of one-stage hybrid treatment. BMC surgery. 2018 Jan 11;18(1):3.