| Summary: | Benign tracheoesophageal fistula (TEF) secondary to foreign body aspiration is not uncommon. An unwitnessed foreign body aspiration with minimal symptoms may have a delayed presentation with significant morbidities including TEF. This case report is of a seven-year old child presenting with new-onset severe airway reactive disease for six months, who was found to have a foreign body lodged in the trachea. The large size of the object made it impossible to pass through the glottis, therefore, a secondary tracheoesophageal fistula was contemplated and later confirmed with contrast study. Repair of the fistula was performed 3 weeks later after optimization of patient condition. The surgical approach was facilitated by insertion of radio opaque guidewire into the fistula via bronchoscopy. This was followed by anterior neck exploration and division of fistula at the upper mediastinum, with primary repair of the trachea and esophagus using vascular muscle flab interposition.
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