Aspiration of foreign body into the airway is a common emergency in pediatric population and has high risk of morbidity and mortality. Clinical presentation of foreign body aspiration varies between children. Some children may present to emergency department with acute life-threatening presentations that require immediate intervention, while others might have long term coarse of symptoms that were misdiagnosed and mistreated for long time. Variation of clinical presentations based on location of dislodged foreign body in the airway tree and size of the aspirated foreign body. Large impacted foreign body creates extra challenge and possible complications during attempt of retrieval via endoscopy alone. We report a case of large aspirated foreign body that had multiple failed attempts of endoscopic removal, and eventually retrieved using combined endoscopic and open approach without tracheostomy. This technique is safe and efficient in cases that failed conventional endoscopy due to large foreign body size.