Esophageal atresia with double fistula: the missed anomaly.

Of the various anatomical types of atresia, that of esophageal atresia and double fistula is said to be the least common. In most series, frequency is less than 1%. Seventy-eight patients with esophageal atresia were treated at the University of Virginia Medical Center between 1955 and 1983. Six of them had esophageal atresia and double fistula, and in 5 of these 6, this anomaly was not diagnosed preoperatively and was not detected intraoperatively. Our experience suggests that proximal "pouchograms" are essential in the preoperative evaluation of these patients to detect the presence of esophageal atresia and double fistula. The morbidity and mortality occasioned by overlooking this anomaly far exceed the risk of the contrast study.