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A case of ulcerative tracheoesophageal fistula following long term respiratory support is described. After establishing the diagnosis of TEF, an attempt at surgical repair should be made as quickly as patient's condition permits it, ideally immediately. We suggest right side thoracotomy with the resection of the fourth rib, thereby facilitating preparation of a pedicled flap which should be interponated between trachea and esophagus after the closure of the esophagus defect by sutures has been performed.
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