2 Figure 1: Contrast esophagogram showing holding up (arrow) of contrast at the level of the diaphragm with evidence of CDH with lower esophageal obstruction. Figure 2: Operative photograph showing a blind ending of the lower esophagus with a sealed perforation (arrow). by van Dooren et al. [5], where there was an atresia of the lower end of the esophagus that was not suspected until the postoperative period. In this case report, there was preoperative diagnosis of a lower esophageal obstruction; hence surgery was done using a chevron (rooftop) incision. This incision allows access for correction of both of the lesions. A feeding jejunostomy is a useful adjunct until the restoration of the esophagogastric continuity. In conclusion, esophageal anomalies are known to occur with CDH. Lower esophageal atresia is a rare association and a preoperative suspicion of this association, clinically, leads to timely correction of both of the lesions. A cheveron incision gives good access to correct both the CDH and lower esophageal atresia. International Journal of Pediatrics Abbreviations CDH: Congenital diaphragmatic hernia GERD: Gastroesophageal reﬂux disease. Acknowledgments The authors acknowledge the contribution of Dr. Leela Kumar, Dr. Hariprasad, and Dr. K. Srinivas in the manage- ment of the patient and preparation of the manuscript. References [1] I. Karnak, M. E. S¸enocak, F. C. Tanyel, and N. B u¨y u¨kpamukc¸u, “Abnormal esophageal anatomy associated with a congenital diaphragmatic hernia: report of a case,” Surgery Today, vol. 31, no. 11, pp. 1005–1007, 2001. [2] C. J. H. Stolar, J. P. Levy, P. W. Dillon, C. Reyes, P. Belamarich, and W. E. Berdon, “Anatomic and functional abnormalities of the esophagus in infants surviving congenital diaphragmatic hernia,” American Journal of Surgery, vol. 159, no. 2, pp. 204– 207, 1990. [3] L. Mart´ınez, S. Gonza´lez-Reyes, E. Burgos, and J. A. Tovar, “The vagus and recurrent laryngeal nerves in experimental congeni- tal diaphragmatic hernia,” Pediatric Surgery International, vol. 20, no. 4, pp. 253–257, 2004. [4] H. Takehara, N. Komi, A. Okada, M. Nishi, and K. Masamune, “Left diaphragmatic hernia associated with lower esophageal atresia,” Pediatric Surgery International, vol. 8, no. 4, pp. 339– 340, 1993. [5] M. van Dooren, D. Tibboel, and C. Torfs, “The co- occurrence of congenital diaphragmatic hernia, esophageal atresia/tracheoesophageal ﬁstula, and lung hypoplasia,” Birth Defects Research Part A, vol. 73, no. 1, pp. 53–57, 2005.