A case of fatal haematemesis associated with a non-traumatic, non-tuberculous aorto-oesophageal fistula in a 9-year-old Nigerian boy is presented. Autopsy revealed two inflamed and ulcerated mild-oesophageal pulsion diverticula, one of which had eroded into the right pleura as a sinus track. The second diverticulum had perforated and caused mediastinitis and eventually aorto-oesophageal fistula which led to the fatal haematemesis. A mild chest injury is seen as a precipitating factor of the haematemesis and not the initiator of the pathology.