Tracheo-esophageal fistula and atresia of the esophagus are not as rare as they are thought to be. Hirsch1 reported 146 verified cases of atresia of the esophagus up to 1920. The commonest type is a blind upper sac and a lower sac opening into the trachea above the bifurcation; 103 of the 146 cases were of this type.
The clinical picture is clearcut. Brennemann2 noted that the first symptom is a constant flow of saliva from the mouth. When given food the infant swallows once or twice without trouble, but with every succeeding attempt at swallowing the fluid is regurgitated through the mouth and nostrils. The child is then compelled to breathe with the nose, mouth and pharynx full of fluid. It suddenly stops nursing; its eyes become fixed; it rapidly turns blue, and then struggles to empty its lungs by coughing. It soon becomes deeply cyanotic. These
JACOBI M, RASCOFF H. CONGENITAL ESOPHAGEAL STENOSIS ASSOCIATED WITH ABERRANT DUCTUS ARTERIOSUS. Am J Dis Child. 1931;42(5):1148-1154. doi:10.1001/archpedi.1931.01940180098016