Case presentation: A 56 year-old female was seen at the rural hospital with a complaint of discharging sinus for four months, prior to this complaint she presented with chronic cough that received several medical treatment including two rounds of full dose of anti-TB were unsuccessful. Surgical exploration of the discharging sinus was performed to discover a sharp metallic object traversing through the neck tissues to the trachea. The original portal of entry was unknown but logged into the trachea and making a thyro-cuteneous discharging sinus, it was successfully removed and patient improved significantly thereafter.

Conclusion: Aero-digestive FB is not uncommon medical conditions that requires immediate attention, misdiagnosis can lead to wrong course of treatment and cultivate more serious complications, aero-digestive endoscopy forms the cornerstone in the diagnosis and treatment however limited by the availability of facilities and expertise in most centers worse in rural setting.