A 27-year-old man was evaluated for sudden onset of massive hematemesis and hematochezia. A bleeding site was not seen on esophagogastroduodenoscopy. There was little blood in the stomach, which suggested that the bleeding site was below the ligament of Treitz. Angiography demonstrated the presence of an intra-aortic metallic foreign body that resembled a sewing needle. At operation, a chronic jejunoaortic fistula that contained the sewing needle was found and repaired. The patient had no recollection of having swallowed the needle, and it is presumed that he ingested it in infancy. He had an uneventful recovery.