65-year-old man, with no previous history of interest, polytraumatised after a car accident. He was intubated at the scene due to severe hypoxaemia and transferred to the critical care unit where, after assessment, a fracture of the left zygoma, lateral wall of the right orbit, fracture of his own bones, fracture of the left clavicle, fracture of the sternum, multiple bilateral costal fractures with left costal volet, subcutaneous emphysema, pneumomediastinum without pneumothorax and fracture of the right pubic ramus. Due to the severe hypoxaemia during mechanical ventilation and the radiological findings, fibrobronchoscopy was performed 72 hours after admission, finding small ulcer-like lesions between the tracheal cartilages, and the orotracheal tube was removed up to the epiglottis for better tracheal visualisation, without observing other alterations. Eighteen days after admission, percutaneous tracheostomy was performed under endoscopic control, placing an 8 mm diameter cannula. Two weeks later, the patient was in a respiratory weaning situation and the tracheostomy cannula was changed. Forty-eight hours after this manoeuvre, the patient presented a new respiratory deterioration with the discovery of air in the enteral nutrition collection bag. A tracheoesophageal fistula was suspected, which was confirmed endoscopically, and the defect was corrected via the oesophageal route with a coated metal prosthesis together with a percutaneous gastrostomy for feeding. The patient died 7 days after cannula replacement due to catecholamine-resistant shock with extreme acidosis and hypoxaemia.