Due to its complications including oesophageal and gastric ulceration and perforation, the Sengstaken-Blakemore tube is used far less commonly in this new millennium where endoscopic intervention is available. We discuss in a 53-year-old Indian woman an unusual life-saving use of the Sengstaken-Blakemore tube in preventing fatal exsanguination from an aortoesophageal fistula, as well as rare but devastating consequences of the insertion and residence of the Sengstaken-Blakemore tube, including acute airway obstruction and bronchoesophageal fistula.