A newborn feeds then vomits every feed, with frothy mucus drooling. A nasogastric tube cannot be passed beyond 11 cm and coils back in the oesophagus on X-ray. There is no gas below the diaphragm. This finding of a gasless abdomen indicates:

• A Pure oesophageal atresia without any fistula ✓
• B Oesophageal atresia with distal tracheoesophageal fistula
• C Tracheoesophageal fistula with intact oesophagus (H type)
• D Oesophageal atresia with proximal fistula only

Explanation

Failure to pass the nasogastric tube with a coiled tube in a dilated proximal pouch confirms oesophageal atresia. Air reaching the stomach requires a communication between the tracheobronchial tree and the distal oesophagus. B gasless abdomen therefore means there is no distal fistula, pointing to pure oesophageal atresia, which occurs in roughly 8 to 10 percent of cases. In the commonest variant, atresia with distal fistula, X-ray shows gas in the stomach and bowel. An H-type fistula presents later with coughing during feeds, not with a coiled tube.

Reference: Pediatric Surgery NaT / Bailey and Love, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.