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Introduction Coin lithium battery ingestion is considered an emergency in pediatric patients that needs to be managed promptly to avoid serious and potentially lethal complications, especially when it is impacted in the esophagus causing severally induced chemical inflammatory tissue reactions destruction/necrosis causing a carotid esophageal-fistula as presented in our caseAbstract C99 Figure 1Case Description 3 years old boy who shows flu like symptoms, intially diagnosed as viral infection, few days after his symptoms progressively deteriorated then brought to the emergency room with severe dysphagia and hemoptysis, Chest x ray showed coin lithium battery impacted in the upper part of the chest at neck origin level, The patient evaluated urgently by a pediatric surgeon, he started to have active bleeding from his oral cavity, then resuscitated and intubated, by endoscopy, lithium battery was removed, but he experienced massive bleed that was evaluated by endovascular intervention found to have actively bleeding dehiscent left common carotid-oesophageal fistula (CCEF). Immediate intervention was performed by deployment of graft sent Core 6mmx5cm along the CCEF point. Then he stayed in pediatric ICU for a few days.The patient shows significant improvement over six months, He was on aspirin that was tapered then stopped. The patient showed significant improvement with remarkable recoveryAbstract C99 Figure 2Conclusions Common carotid-oesophageal fistula CCEF was successfully treated endovascularly with grafted stenting as a lifesaving with remarkable outcome.Abstract C99 Figure 3Conflict of Interest No