A tracheoinnominate artery fistula case that presented as hematemesis in a 21 years old man with Duchenne muscle dystrophy. A tracheoinnominate artery fistula is a life threatening complication after surgical tracheostomy. The peak incidence is between the first and second week. Immediate management includes overinflation of tracheostomy cuff and/or direct digital compression. Surgery is the definitive treatment. The survival rate in patients who receive immediate surgical management ranges from 14.3% to 53%.