Peri-operative management of a neonate with tracheo-oesophageal fistula and anorectal malformation: Survival of the fittest

Oesophageal atresia (OA) with tracheo‐oesophageal fistula (TOF) is a rare congenital anomaly usually seen in association with the VACTERL spectrum of disorders in neonates.[1] Management of these groups of anomalies is generally an early surgical intervention in most cases. Majority of neonates are managed with a palliative procedure until fit for a definitive surgery.[2] Isolated case reports have been published about management of multiple defects.[3,4] We describe a case of a neonate with a high anorectal malformation (ARM) along with TOF who was managed surgically in a single setting for both defects. The pathophysiology of TOF gets further accentuated in a setting of ARM as there is absolutely no way to decompress the bowel, either from above or below. This calls for an urgent intervention in the form of a colostomy/gastrostomy or definitive repair, given further compromise of the already susceptible lungs.