Acquired tracheo-oesophageal fistula (TEF) after tracheostomy is a life threatening complication and can occur in about 1% of cases of tracheostomy. Percutaneous tracheostomy was performed in intensive care unit on a 40 years male patient for long-term mechanical ventilation. Subsequently patient developed TEF as the complication of tracheostomy. He was initially managed with endoscopically inserted self expanding plastic stent but later on required surgery for definitive repair. The problems associated with acquired TEF and its management are discussed hereby.