A 68 year-old female patient, with surgical treatment for duodenal ulcer. The postoperative outcomes were difficult, with ARDS and prolongued mechanical ventilation and tracheostomy. 30 days after the tracheostomy, the tracheo-esophageal fistula caused by balloon compression on the tracheal wall was discovered. Thoracic scans (Fig. 15), bronchoscopic and esophagoscopic exams showed a tracheo-esophageal fistula at cervical trachea, at the level of previous tracheostomy.
Treatment 
Horizontal cervicothomy "en verre Bordeaux". The dissection of trachea and esophagus revealed the fistula and its resection, together with a small portion of the membranous wall of the trachea. Tracheal suture with 4.0 resorbable and esophagus with resorbable 4.0, duble layer and interposition between these 2 suture lines of muscle pedicle (Fig. 16).
Postoperative outcomes were favorable. After aproximatively 6 months, the patient requested temporary Montgomery stent and bronchial dilatation due to a tracheal stenosis developed at the level of tracheostomy.
Eso-respiratory fistula is an abnormal communication between esophagus and the respiratory tree. The ethiology is: congenital (with or without esophagus athresia) or aquired (trauma, iatrogenic or neoplasia) [].
This etiology type (except for neoplasic fistulas) is frequently correlated with anatomo-clinical forms of eso-bronchial fistula:
- Congenital eso-respiratory fistulas are usually tubular, longues, and facilitate surgery [].
- Infectious eso-respiratory fistulas (tuberculosis, empyeme, and mediastinitis) are diverticularly shaped, sclerous; all these caracteristics make surgery very difficult.
- Traumatic eso-bronchial fistulas are the most difficult to dissect and to suture [].
The presence of eso-respiratory fistula caused the aspiration of esophageal content into the bronchial tree, leading progressively to congestion, bronchial and lung infections with bronchial occlusion, athelectasy, respiratory distress and exitus. Usually, eso-respiratory fistulas are followed by piosclerosis and lung abscess [].
Clinical features: productive cough (after water or food ingestion), expectoration with previous ingested food.
In over 70% cases, eso-respiratory fistulas could be diagnosed after barium ingestion X-Ray exam. Esophageal endoscopy and bronchoscopyc exams are useful to evaluate these fistulas, especially after the instillation of a coloured solution (metilen blue).
With regard to fistulas' etiology, therapy is neccessarily surgical [] and should not be delayed. Spontaneus healing of fistula is seldom (we could say, exceptional) and fistulas' occlusion with acrylic polymer or electrocauterisation are controversial. Paleativ procedures such as endotracheal or esophageal stents could be experimented on inoperable patients []. However, these procedures depend on ethiology and they take place with or without esophageal by-pass.