Tracheoesophageal fistula and massive pneumoperitoneum after prolonged mechanical ventilation

We describe a patient who had two unusual complications of prolonged mechan ical ventilation-tracheoesophageal fistula and pneumoperitoneum-with a fata l outcome. Recurrent pulmonary aspirations and massive abdominal distention in the setting of longstanding artificial ventilation should alert the phy sician to these possibilities.