Tracheomalacia refers to diffuse or segmental tracheal weakness. Most commonly,
tracheomalacia develops after prolonged endotracheal intubation or
tracheostomy. Surgical management is warranted in symptomatic patients with severe
tracheomalacia. Relief of
airway obstruction via stenting often provides immediate improvement in both airflow and symptoms. However,
stent placement is associated with significant complications. Here, we present the case of a 71-year-old man who was brought to the emergency department with acute respiratory distress. The patient was known to have
tracheomalacia with
tracheoesophageal fistula. He had multiple medical comorbidities, including longstanding
hypertension,
diabetes mellitus, and
asthma. The patient had a progressive decline in his level of consciousness and was admitted to the intensive care unit for further management. Despite the maximum ventilatory support, the patient did not achieve an adequate oxygenation level. The patient underwent tracheal
stent placement by the interventional radiology team. The insertion was unsuccessful despite three attempts. The tracheal
stent had migrated into the upper esophagus on the first and second insertion attempts. Because the patient was unstable to tolerate further attempts, the multidisciplinary team recommended the insertion of an esophageal
stent to cover the
tracheoesophageal fistula. Despite this, the patient continued to have air leakage with progressive worsening of his respiratory condition as he developed multiorgan failure and died. The management of
tracheomalacia in the setting of the
tracheoesophageal fistula may pose several challenges. The present case highlights an essential complication of
stent placement with the
stent migrating into the
tracheoesophageal fistula, which is an unusual site of migration. A multidisciplinary approach is crucial in the management of difficult cases of
tracheomalacia.