Tracheoesophageal fistula is an abnormal communication between the trachea and the oesophagus. It can be congenital or acquired. In the adults’ patients, acquired causes are more common than congenital. And then malignant fistulas are more common than benign ones. Tracheoesophageal fistulas are often the complication of a tracheotomy, of prolonged endotracheal intubation, especially when there is a nasogastric feeding tube. They can also occur after chest trauma, be of infectious or/and neoplastic origin. Successful management is hinged on prompt diagnosis and tailor-made surgical care. The aim of this article is to report a rare case of tracheal fistula in adults whose diagnostic and therapeutic management was difficult. Acquired tracheoesophageal fistula with atypical respiratory symptoms may be mistaken for other more common clinical entities. Different factors including misdiagnosis and delayed presentation can both play a role in delaying management which is an important factor in the eventual clinical outcome of these patients. Certain patients are able to cope with progressively worsening respiratory symptoms attributable to TEF until it becomes unbearable thereby putting them at risk of significant perioperative morbidity and mortality as surgery is still the main stay of management. Diagnosis of tracheal oesophageal fistula must lead to in-depth investigations and appropriate emergency treatment. 

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