Esophageal foreign bodies are common in clinical practice, with fishbone-associated esophageal foreign bodies being the most common ones in adults. Asia shows a higher incidence compared with western countries.While a case of the foreign body-induced esophageal perforation and rupture of the posterior wall of the left atrium, which causes periatrial abscess and eventually results in systemic embolism is quite rare. Therefore, here we report a case of acute cerebral infarction secondary to a fishbone piercing the left atrium and periatrial abscess formation.