Hindawi Publishing Corporation International Journal of Pediatrics Volume 2010, Article ID 738546, 2 pages doi:10.1155/2010/738546 Case Report A Rare Association of Congenital Diaphragmatic Hernia with Lower Esophageal Atresia and Perforation Narendra Kumar Are, K. Nagarjuna, and Lavanya Kannaiyan Department of Paediatric Surgery, Niloufer Hospital for Women and Children, Osmania Medical College, Hyderabad 500 017, India Correspondence should be addressed to Narendra Kumar Are, naren are@yahoo.com Received 20 May 2010; Accepted 15 June 2010 Academic Editor: Frans J. Walther Copyright © 2010 Narendra Kumar Are et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Congenital diaphragmatic hernia is known to be associated with esophageal atresia, which is a rare association. We report a rare occurrence of congenital diaphragmatic hernia and lower esophageal atresia. 1. Introduction Abnormalities of the esophagus such as gastroesophageal reﬂux disease (GERD), esophageal motility disorders, eso- phageal duplications cysts, and tracheoesophageal ﬁstula with esophageal atresia are rare but documented occurrences with congenital diaphragmatic hernia [1, 2]. We report a rare association of lower esophageal atresia with congenital diaphragmatic hernia (CDH). 2. Case Report A 10-day male child presented with respiratory distress with- out cyanosis since birth. On clinical examination, patient had tachypnea, with a scaphoid abdomen. The persistent drooling of saliva led to the suspicion of esophageal atresia. A red rubber catheter was passed into the esophagus, but there was resistance at 15 cm from the alveolar margin. Chest X-ray showed evidence of left CDH with mediastinal shift and the tip of nasogastric tube at the level of the diaphragm. A contrast esophagogram was done which showed holdup of dye at the level of the diaphragm (Figure 1). With the suspicion of associated esophageal obstruction and CDH, a laparotomy was done using a chevron incision. The operative ﬁndings include left posterolateral CDH, complete disruption of the esophagogastric junction with a blind- ending esophagus, and a sealed esophageal perforation at the esophagogastric junction (Figure 2). The surgical correction included repair of CDH and esophagogastric anastomosis with a feeding jejunostomy. The postoperative course was uneventful. Jejunostomy feeds were started on the 4th postoperative day. Contrast esopha- gogram was done on the 10th postoperative day. It showed free ﬂow of dye into the stomach. At discharge, the child was on full oral feeds. He has been followed up for 3 months. The child’s general condition is good with adequate weight gain. 3. Discussion Esophageal anomalies are known to be associated with CDH. These associations include tracheoesophageal ﬁstula with esophageal atresia, GERD, esophageal dysmotility, esophageal duplication cysts, and esophageal ectasia [1, 2]. The possible noted explanations include the kinking of the esophagogastric junction [2] and abnormal innervation of the esophagus by the vagus and recurrent laryngeal nerve [3]. Tracheoesophageal ﬁstula with esophageal atresia is a known association of CDH, albeit a rare one with an incidence of 0.005 per 1000 births [4]. In this case report, there is atresia of the lower esophagus at the esophagogastric junction. It appears to be an acquired event probably due to vascular compromise by the acute kinking of the stomach in the thorax because of the CDH. In an extensive review of the English literature, there is only one similar case reported