Foreign body–induced aorto-oesophageal fistula is a rare cause of massive upper gastro-intestinal bleeding and, in the absence of a timely diagnosis and surgical intervention, can be fatal. During a period of 25 years, five patients with foreign body–induced aorto-oesophageal fistula underwent surgery in our department. Three patients survived. All survivors required more than one surgical intervention. The clinical course of these five patients and the management of this potentially fatal condition are reviewed.