Tracheo-oesophageal fistula (TEF) is an uncommon and potentially life-threatening complication of blunt chest trauma. We describe our surgical experience in a patient with huge TEF (5.6 cm in diameter) and evaluate the short-term results of surgical management by oesophageal exclusion (cervical gastro-oesophagostomy) and show that the use of oesophagus segment in situ as replacement of the posterior membranous wall of the trachea is feasible. Improving the nutrition status and controlling the lung infection were critical in the perioperation period.