A 65-year-old woman presented with haematemesis and syncope with head strike on a background of a week of intermittent dysphagia and odynophagia a week after eating a fish salad. CT-brain showed a 4cm radiopaque oesophageal foreign body penetrating the aortic arch with surrounding mediastinitis. The decision was made to proceed with a hybrid endovascular and endoscopic approach. Vascular surgeons inserted a 34x100mm GORE CTAG endoluminal stent-graft immediately distal to the left subclavian artery and in the proximal descending aorta, ready for rapid deployment, via femoral approach. A gastroscopy was then performed where the foreign body was identified as a fish bone, which was transecting the oesophagus, with contralateral perforations, with extrinsic oesophageal compression. The bone was grasped with rat-tooth forceps, and with the slightest traction, brisk aorto-oesophageal bleeding was encountered. The remainder of the aortic stent was then deployed, which then swiftly achieved haemostasis. Once the 400mL of blood was suctioned away and endoscopic views restored, the fish bone was seen with the proximal end located intraluminally in the oesophagus, where it could be easily grasped with rat tooth forceps and removed safely with an angled tip distal cap. A repeat gastroscopy performed by oesophagogastric surgeons 12 hours later re-assessed the perforations, found improved extrinsic compression, and clipped the perforations closed. The patient was extubated the following morning and was well, discharging home well on day 18 after admission on oral antibiotics and weaning nasojejunal tube feeds, tolerating oral diet.