question: Background Montgomery T-tube (MTT) is a useful airway device but seldom used. Due to its specific shape and structure, it is challenging for anesthesiologist to manage airway in patients with MTT in situ who requiring general anesthesia and continuous positive-pressure ventilation (CPPV). Case A 48-yr-old and 74kg man, with a MTT in situ, was scheduled for local pancreatic resection under general anesthesia. We transorally inserted a cuffed endotracheal tube into the intratracheal limb of MTT to achieve CPPV and the delivery of inhalation anesthetic. Endotracheal tube was removed successfully after the patient fully recovered from anesthesia. No tracheal injury or hemorrhage occurred after intubation or extubation, and the location of MTT was unchanged. Conclusions Transorally insert a cuffed endotracheal tube into the intratracheal limb of MTT could be considered as a safe and feasible approach for airway management.