Diagnosis and airway management in a neonate with laryngeal atresia, tracheal agenesis and a broncho-esophageal fistula: A case report

Tracheal agenesis is a rare congenital anomaly that is usually fatal and occurs in approximately 1:50,000 births. The diagnosis is usually made when there is failure to perform endotracheal intubation in a neonate with severe respiratory distress and absence of audible cry. We present a case of a newborn with suspected trachea-esophageal fistula who presented to the operating room for ligation of the fistula. The diagnosis of laryngeal atresia with tracheal agenesis was made intraoperatively when attempts at surgical ligation of the fistula resulted in difficulty with ventilation and a loss of the capnograph. Ventilation of the lungs was possible with an esophageally placed tube via an esophago-bronchial fistula. This case highlights the importance and need for good communication and teamwork between surgeons, anesthesiologist, radiologist and neonatologists.