Figure 1.

Patient was intubated and ventilated with rigid bronchoscopy. The tracheostomy cannula was removed and endoscopic view showed a tracheo-esophageal fistula localized 3.5 cm below the vocal folds and extended 3 cm distally. Standard 4/0 vycril needle was bent to a 90 degree angle to facilitate surgical maneuvers into a tight and angled anatomical district as trachea. The needle holder was then passed through the tracheostomy and under endoscopic view the tear was completely closed with interrupted stich. Finally, Montgomery T tube was inserted in a standard manner to protect the suture and maintain the air-way patency. Three-dimensional reconstruction of computed tomography study with an oral contrast swallow showed the complete healing of the fistula (5). Available online: http://www.asvide.com/articles/1426