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A 44-year-old woman presented with unremitting chest pain after a fish meal. A fishbone had been stuck in her esophagus overnight. A local endoscopist had tried to remove it but had failed. Contrast-enhanced computed tomography (●" Fig.1) confirmed that there was a high density line shadow in the esophagus just below the tracheal bifurcation. The fishbone had pierced the esophageal wall andwas close to thedescending aortic adventitia, and possible aortic injury was strongly suspected. Standard cardiovascular surgery was planned, but was refused by the woman and her relatives because of the potentiallymassive surgical trauma. With written informed consent, an innovative endoscopic strategy involving multidisciplinary cooperation was successfully employed (●" Video1). Using endoscopic imaging, only the tip of the fishbone could be observed, 28cm from the incisors (●" Fig.2). Grasping forceps were introduced and the 2.2cmlong fishbone was successfully retrieved (●" Fig.3). Then fresh blood immediately spurted out. After flushing with normal saline, a Sengstaken–Blakemore tube (SBT) was immediately inserted. The gastric balloon was placed accurately over the mucosal wound, inflated with 100mL of gas, and adjusted for local compression Fig.1 Contrast-enhanced computed tomography scan of a 44-year-old woman with a fishbone stuck in her esophagus. The fishbone had pierced the esophageal wall and was close to the descending aorta (arrow).

Endoscopic retrieval followed by compression hemostasis using a Sengstaken–Blakemore tube to manage a foreign body with suspected aortic injury