A 76-year-old woman with a distant history of right diaphragmatic hernia repair with permanent mesh and subsequent laparotomy for mesh migration presented with pneumonia. On initial presentation esophagogastroduodenoscopy and computed tomography showed a contained esophageal perforation with residual permanent mesh. Although the patient initially deferred esophagectomy, a right lower lobe lung abscess developed necessitating mesh resection and an Ivor Lewis esophagectomy. We present the first case of mesh migration and erosion through the esophagus and right lower lobe of the lung. Permanent mesh should not be used during hiatal hernia repairs because of complications such as mesh erosion.