A neonate, handed over to mother after a normal examination, was brought back at 4 hours with regurgitation of first feed, drooling of saliva and respiratory distress. An 8F stiff catheter could not be passed beyond 9 cm from the gum margin. X-ray showed the tube in the lower neck with normal lung fields and stomach gas. A diagnosis of esophageal-atresia (EA) with tracheo-esophageal fistula (TEF) was made. Thoracotomy revealed normal esophagus and trachea without a fistula. A gastrostomy was performed. Symptoms continued in the postoperative period. Flexible endoscopy and CT scan showed a mass in the upper esophagus. Rigid endoscopy, performed with a view to obtain biopsy, showed a whitish "mass". A 2 cm ball of cotton wool was removed and the child recovered. In retrospect it was found that a relative had put honey soaked cotton wool in the child’s mouth after birth as a religious custom.

Most reported cases of esophageal FB in infants have been of accidental ingestion presenting well beyond the neonatal period(1). We did not come across a report of a case as young as 4 hours.

We are inclined to change our practice after this experience. We now choose to perform preoperative bronchoscopy in clinically diagnosed EA. It confirms or excludes the diagnosis, defines the level, number and size of the fistula, and also the fistula can be occluded to improve ventilation.

S.K. Aggarwal,
Rajat Gupta,
Department of Pediatric Surgery,
Maulana Azad Medical College and
Lok Nayak Hospital,
New Delhi 110 002, India.
E-mail: [email protected]

1. Nanci P, Ong A. Foreign body in the esophagus: Review of 2394 cases. Brit J Surg 1978; 65: 5-10.