We report a difficult case of tracheostomy in a 34-year-old obese woman with a short neck. The tracheostomy tube placement repeatedly failed because of anatomical changes due to obesity and a short neck, tracheal mucosal swelling due to prolonged intubation, and unexpected false passage; however, it was successfully performed using an endotracheal tube exchanger as a guidewire.
Keywords: Guidewire; Obesity; Tracheostomy.