The use of endovascular aortic occlusion (REBOA) is an adjunct for resuscitation in patients with severe hemorrhage. This case is a rare presentation of foreign body ingestion causing esophageal injury, cardiac injury and suspected aortic injury. After ingestion of a needle a patient presented with severe chest pain and exploration showed frank blood in the chest. Due to the suspicion of aortic injury, aortic exploration was needed. A new twist in the management was the use of REBOA to control the aorta proximally without the need for proximal dissection. Exploration and repair of left atrial injury and esophageal injury after extraction of the foreign body. This new modification to the use of REBOA allowed for safe exploration of the aorta and good control in case of encountered injuries. Repair of the esophageal injury in two layers. Patient recovered in the SICU then shifted to the floor and discharged after tolerating normal diet.