Ten weeks after placement of the occluder, the patient returned for a routine control visit. She reported a symptom-free period of 3 weeks. In week 4 after insertion of the occluder, the chronic cough had recurred; in week 9, halitosis, expectorations, and minor hemoptysis developed. Clinically, she had no fever, and C-reactive protein as well as leukocytes and hemoglobin levels were normal. Chest radiography showed that the occluder was slightly dislocated toward the bronchial system, and the esophageal end was only incompletely expanded. CT ruled out pulmonary abscess and infiltration. During esophagoscopy, the esophageal end of the fistula was clearly visible; fluoroscopically, the occluder appeared retracted into the mediastinum and was incompletely expanded. However, esophageally applied fluid did not reach the bronchial system. Bronchoscopy revealed increased mucosal vulnerability in segment 6 to be the origin of hemoptysis, but the bronchial end of the occluder could not be reached for extraction. The patient recovered under antibiotic therapy (piperacillin and combactam, three 4.5-g doses per day IV for 3 days and then mofloxacin, 400 mg po qd for 10 days) and could be discharged 5 days after hospitalization.