Achalasia manifests as lack ofperistalsis of the esophagus. It is a common disease of a usually benign course. The incidence of esophageal-bronchial fistulahas been reported in the literature. In this study, we present the case of a patient, who was previously diagnosed with achalasia. He was received at the emergency department (ED) having respiratory failure and cardiopulmonary arrest. Resuscitation followed by radiological and laboratory workup revealed acute respiratory distress syndrome and bilateral esophageal-bronchial fistulas. Attempt to do surgical intervention was limited due to the severe sepsis and compromised respiratory status of the patient. Discussion of this case in light of the literature findings reveals the possible treatment methods and prognosis of similar conditions.