Percutaneous tracheostomy is more and more used in the intensive care units. However, it's not devoid of risks. We report the case of a patient who developed a tracheo-esophageal fistula discovered after removal of the cannula 23 days after tracheotomy. During the procedure, difficulties occurred during the insertion of the cannula. This case report reminds the importance of a peroperative continuous endoscopic guidance and the need of a rigorous learning.