Regarding oesophageal atresia and tracheo-oesophageal fistula, the following statements are TRUE:

• A. True
• B. False: A gasless abdomen indicates the ABSENCE of a distal fistula; gas in the bowel signals a distal TOF.
• C. True
• D. True
• E. False: The baby is kept nil by mouth with continuous upper-pouch suction; feeding is contraindicated as it risks aspiration.

Oesophageal atresia and TOF

Oesophageal atresia arises from failure of the foregut to separate into trachea and oesophagus. Recognising the antenatal clues, presentation, associations and initial management is core paediatric surgery.

Antenatal and neonatal features

• Polyhydramnios from failure to swallow amniotic fluid; small or absent stomach bubble; dilated upper pouch.
• Postnatally: drooling of frothy saliva, choking, coughing, cyanotic spells after feeds, respiratory distress, and resistance to passing an NG tube beyond 10-15 cm.

X-ray interpretation

• Coiled NG tube in the upper pouch confirms atresia.
• Gas in the bowel = distal TOF (air reaches the gut through the fistula).
• Gasless abdomen = NO distal fistula (pure atresia).

VACTERL associations (about 50%)

Vertebral, Anorectal, Cardiac, Tracheo-oesophageal, Esophageal, Renal, Limb.

Initial management

Nil by mouth, continuous suction of the upper pouch, IV fluids, oxygen, head-up positioning; then thoracotomy to divide the TOF and anastomose the oesophagus.

Statement-by-statement verdict

Why A is true

Polyhydramnios from impaired fetal swallowing is a recognised antenatal sign.

Why B is false

A gasless abdomen indicates no distal fistula; gas in the bowel indicates a distal TOF.

Why C is true

VACTERL anomalies occur in around half of cases.

Why D is true

Drooling and choking with feeds is the classic presentation.

Why E is false

The baby is kept nil by mouth with continuous upper-pouch suction; early feeding risks aspiration.