Acquired trachea-esophageal fistula (TEF) is a rare condition in adults and causative factors include malignancy, trauma and various iatrogenic causes. The important causative factor of TEF in our case was percutaneous tracheostomy. The normal protective laryngeal reflexes are lost in TEF due to the patent tract from the airway to the upper gastrointestinal tract. The TEF poses a challenge for the surgeon and the anaesthesiologist, as the fistula lies in close proximity to oesophagus, trachea, upper mediastinal contents and large blood vessel. Here we present a rare case of anesthetic management of a 26 year old male patient with complaints of regurgitation of part of swallowed food particles through an in-situ tracheostomy tube since two years.
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