Background: Recurrence of tracheoesophageal fistula is afrequent complication after esophageal atresia repair. Acquiredtracheoesophageal fistulas are long new fistulas that are localized atsites that are not typical of the congenital tracheoesophageal fistula.We present four cases to discuss the diagnostic and managementchallenges concerning various acquired tracheoesophageal fistulalocalizations.Case Report: We retrospectively evaluated the medical records ofpatients admitted with acquired tracheoesophageal fistula in the last 5years. Among the 16 postoperative tracheoesophageal fistulas, 4 wereclassified as acquired tracheoesophageal fistula. Patients’ admissionage ranged from 1 to 8 years. The female to male ratio was 2:2.The presented cases were admitted with recurrent respiratory tractinfections, choking, and coughing. The acquired tracheoesophagealfistulas were observed between the esophagus and cervical trachea,between the esophagus and the right bronchus passing throughintrathoracic abscess cavity, in the right bronchus, and between thecolon conduit and trachea. One of the acquired tracheoesophagealfistulas healed spontaneously, whereas others required surgicalligation.Conclusion: Acquired tracheoesophageal fistula most oftenoccurs secondary to local or diffuse mediastinitis. Acquiredtracheoesophageal fistula may appear at unusual sites not typicalof congenital tracheoesophageal fistula, such as esophagus-to-rightbronchus and conduit to trachea. Therefore, the unusual locationsof acquired tracheoesophageal fistula should be borne in mind, andpatients evaluated and managed more comprehensively.