Esophageal atresia and tracheoesophageal fistula in the twin: anatomic variants

Recent experience with a twin who had esophageal atresia and tracheoesophageal fistula revealed complex anatomy not suspected before operation. The experience in patients with esophageal atresia and tracheoesophageal fistula who were twins was reviewed at the Children's Hospital of Los Angeles. Of 245 patients seen in the past 23 years, 16 were twins (only two of whom were siblings). Six of the 16 patients (38%) had other than the most frequent anatomy, i.e., proximal atresia of the esophagus and distal fistula. Two of these patients had extremely complex anatomy. Twenty-five per cent of the patients had a right aortic arch compared with 5% of all patients with tracheoesophageal fistula. The surgeon who encounters a twin with esophageal atresia or tracheoesophageal fistula is appropriately cautioned that significant anatomic complexity may be encountered.