The prodromal symptoms of the occurrence of esophageal fistula are often not systemic, but merely neck discomfort, swelling and pain, combined with swallowing discomfort; local swelling and pressure pain on the more normal side, but usually the swelling and pressure pain after surgery feels normal and difficult to draw our attention to, the more characteristic signs are the local skin is dark red and the mass is progressively enlarged. Treatment measures: Once the diagnosis is clear, a rapid evaluation of the patient’s condition, ventilation, nutritional status, and state of water-electrolyte disturbance should be given immediately, and then drainage and remedial surgery should be performed without hesitation. Preoperative control: Preoperative preparation should begin when this diagnosis is suspected, such as fasting, aspiration of mucus in the oral and proximal esophagus, insulation, hydration, and parenteral nutritional support. Use antibiotics if necessary. The preoperative use of intravenous metformin to reduce the acidity of the gastric juice and its continued use until the anastomosis heals has not been universally accepted. The child should be transferred in a horizontal, lateral or semi-ambulatory position. Accompanied by an experienced physician or/and nurse with oxygen, warming conditions and suction. Every effort should be made not to use an artificial ventilator before surgery to prevent gas from entering the gastrointestinal tract through the fistula, which could cause a diaphragmatic rise, aggravate respiratory distress, and even gastric perforation.