Esophagogastric fistula or double-lumen esophagus is a rare condition. There have been fewer than 15 reported cases in adults and only one reported case in the pediatric population. Esophagogastric fistulas typically develop in patients with preexisting gastrointestinal reflux, esophagogastric surgery, esophageal ulcers, or carcinoma. Our case involves a 5-year old girl presenting with odynophagia and nocturnal cough who had a prior Nissen fundoplication. She was found to have an esophagogastric fistula. Conservative management with esophageal dilatation and proton pump inhibitors was not successful. However, a repeat Nissen fundoplication with fistula repair relieved the patient of her symptoms. Level of evidence: Level V; Case report.