Background: Acquired tracheal/bronchoesophageal fistula (T/BEF) is a morbid condition associated with trauma, malignancy, chronic infections or inflammatory diseases. The resulting fistula presents life threatening complications including recurrent aspiration pneumonia, severe malnutrition and risk of mediastinitis. Conservative, endoscopic and ultimately surgical repair are the treatment possibilities. Surgical repair, however, presents severe technical and ventilatory concerns as intubation and single lung ventilation become almost impossible. To facilitate safe surgical repair, veno-venous extracorporeal membrane oxygenation (VV-ECMO) may be utilised. Case: We report a case of chronic left-BEF secondary to erosive B-cell lymphoma, without radiotherapy, in a 30 year old female which was managed endoscopically over 24 months; with oesophageal and tracheal stenting. This ultimately failed due to stent erosion resulting in massive T/BEF and aspiration pneumonia, necessitating surgical repair. VV-ECMO was employed to allow repair of T/BEF while protecting the contralateral lung. We also describe our repair technique for this challenging case. VV-ECMO was continued post operatively to provide an ultraprotective ventilatory strategy in the post-operative period. The patient was weaned from ECMO and extubated two days later with good recovery at the time of writing. Conclusion: This is an interesting case of massive T/BEF which was successfully managed surgically with the use of VV-ECMO intra and post operatively.