Endoscopic balloon dilation of tracheal stenosis is usually a safe procedure. However, there are life-threatening complications that physicians performing the procedure need to be aware of. A 43-year old woman with a multi-level tracheal stenosis following lengthy intubation and a tracheostomy was treated with endoscopic balloon dilation. This resulted in an almost total rupture of the posterior tracheal wall. Here a safe and successful conservative treatment approach is reported.