Mediastinal pleural fistula is a life‑threatening disease. With the development of digestive endoscopy, there is an increasing possibility of mediastinal pleural fistula during resection for esophageal tumor; timely detection of hydropneumothorax, early drainage and anti‑infectious treatment are essential to improve prognosis. Herein we present a case of mediastinal pleura fistula caused by perforation during resection for esophageal tumor under general anesthesia, so as to provide evidence for anesthetic management and perioperative management of related diseases.