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Introduction: Laparoscopic sleeve gastrectomy (SG) is an effective method for the treatment of obesity. Leakage is the most common and unfavorable complication of SG. Use of self-expandable metal stents (SEMS) has become the gold standard management. Aortoesophageal fistula (AEF) is a rare and life-threatening complication that can result from SEMS placement. Case Presentation: A 52 year old woman underwent laparoscopic SG for morbid obesity. Eight days after an esophagogastric SEMS placement was required for gastric leakage. Twenty two days later she presented massive hematemesis and active AEF was diagnosed requiring endovascular placement of thoracic endoprosthesis. SG conversion into Roux en Y gastric bypass (RYGB) with double pigtail stent placement was necessary for the persistence of gastric fistula. 45 days after, EGD revealed the aortic prosthesis at the distal portion of esophagus. For this reason, she underwent a thoracic aorta reconstruction and an esophago jejunal anastomosis. Discussion: Esophageal ulceration is a possible complication of SEMS placement and can lead to an AEF. In order to promptly identify and treat rare and fatal complications as AEF, it is important to always keep a high index of suspicion. Conclusion: The awareness of rare complications as AEF after SEMS placement is important in order to facilitate immediate surgical treatment and to raise survival possibility. It is important to be familiar with all different treatment options, as well as being updated on the latest Guidelines. A good knowledge of timing and best treatment option, depending on the leak and patient clinical status, are mandatories.