Upper gastrointestinal bleeding following swallowing a foreign body is often caused by a fistula between the large arteries and esophagus, which causes severe and fatal bleeding.

A 24-year-old woman presented with severe bleeding in the upper gastrointestinal tract after unwanted swallowing a toothpick. Due to unstable hemodynamic conditions, endoscopic evaluation was not possible, and she was immediately transferred to the operating room. The source of the bleeding was the upper part of the esophagus, as the site of the bleeding was temporarily packed and ceased the surgery. CT-angiography of the head and neck arteries showed esophageal to carotid fistula.

Esophageal fistula of large arteries usually causes severe bleeding. Awareness from of warning signs and timely diagnosis may propose better clinical outcomes.