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The clinical picture and anatomical variants of oesophageal atresia are well known now that this condition can be treated surgically with fair hope of success. In about 90 % of cases there is a fistula connecting the lower segment ofthe oesophagus to the trachea and in some 9 % the atresia is present alone without a fistula. Amongst the remainder there are instances where the fistula passes from the upper pouch to the trachea, where there is a fistula connecting each segment to the trachea and where a fistula occurs without any atresia (Waterston, 1954). In the case of the infant described here, however,though in life the findings did not appear out of the ordinary, autopsy revealed a most unusual malformation and it is perhaps fortunate that the child's general condition precluded any attempt at surgical correction.Case History A male child, birth weight 6 lb., was born rapidly at home five weeks before term. The pregnancy had been uneventful and he was the third child of healthy parents, the mother's age being 23. Respiration could not be established and atresia of the oesophagus became apparent when a catheter could not be passed into the stomach. Intermittent gasping respiration followed mouth-to-mouth insufflation and the child was transferred to hospital where, following intra-tracheal oxygen, a more regular, but stertorous and rattling, respiration was established about two and a half hours after birth.The child remained limp and unresponsive, with intermittent cyanotic attacks and a low temperature. Numerous rales were audible all over the chest and the intestines filled with air. After some hours the intra-tracheal tube was removed but, as the child's condition and colour promptly deteriorated, it was reinserted, this time rather further than before. It was then noted that the condition remained poor until the tube was withdrawn a short way, but the significance of this was not appreciated until autopsy. After 36 hours, during which time the child never developed muscle tone or became responsive, the stertorous respirations became periodic and death followed at 48 hours.

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