Abstract
Tracheoesophageal fistula (TEF) is a rare but devastating complication that can arise in patients with esophageal cancer following multimodal therapy. We present the case of a 45-year-old male with stage III esophageal adenocarcinoma treated with neoadjuvant chemoradiation, followed by esophagectomy and immunotherapy. He subsequently developed a large TEF, resulting in recurrent aspiration, bleeding, and ultimately death despite comprehensive supportive measures. TEFs are associated with significant morbidity and mortality, and current therapeutic strategies remain limited. However, promising advances in endoscopic modalities and reconstructive surgery are emerging. Management necessitates a multidisciplinary, individualized approach, although standardized guidelines are currently lacking. Our case underscores the need for vigilance in patients at risk for TEF and the critical importance of early diagnosis and tailored intervention to prevent life-threatening complications.