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Embryology · Respiratory system, diaphragm and body cavities

Esophageal atresia and tracheoesophageal fistula !

  • Malformation

The esophagus ends in a blind pouch and often connects to the windpipe. The newborn drools, chokes and turns blue when fed.

Updated 2026-11-01

See it in 3D: Esophagus · Trachea · Stomach

What it is

Esophageal atresia is a break in the esophagus, nearly always with an abnormal connection to the trachea. It results from faulty division of the foregut by the tracheoesophageal septum in week 4. It occurs in about 1 in 3,000 to 5,000 births and often comes with other anomalies, such as those of the VACTERL association.

Embryological cause

  • Week 4: the respiratory diverticulum buds from the foregut and stays joined to it.
  • Two tracheoesophageal ridges grow and fuse to form the tracheoesophageal septum.
  • The septum divides the foregut into trachea (ventral) and esophagus (dorsal).
  • If the septum deviates backwards or is incomplete, the esophagus is interrupted or left connected to the trachea.
  • Variants: isolated atresia without fistula and H-type fistula without atresia (each about 4 %).

How it presents

  • Newborn with excessive, frothy saliva.
  • Coughing, choking and cyanosis with feeds; immediate regurgitation of milk.
  • Aspiration pneumonitis from saliva or gastric contents through the fistula.
  • Abdominal distension as air passes from the trachea to the stomach through the distal fistula.
  • H-type fistula shows up later with recurrent pneumonia and coughing with feeds.
  • About a third have heart disease; look for vertebral, anal, renal and limb anomalies (VACTERL).

Diagnosis

  • Prenatal ultrasound: polyhydramnios with a small or non-visible stomach; sometimes a dilated esophageal pouch.
  • At birth, a tube cannot be passed into the stomach.
  • Chest and abdominal X-ray: tube coiled in the pouch, and presence or absence of bowel gas.
  • Echocardiogram and renal ultrasound to look for associated anomalies.

Test yourself

Think of the answer, then tap the question to see it.

Which embryonic structure fails in esophageal atresia with tracheoesophageal fistula?

The tracheoesophageal septum, which in week 4 should divide the foregut into trachea and esophagus.

What is the commonest type of esophageal atresia?

The proximal esophagus ends blindly and the distal esophagus connects to the trachea; about 90 % of cases.

Which prenatal sign suggests esophageal atresia?

Polyhydramnios with a small or absent fetal stomach, because the fetus cannot get swallowed fluid to the intestine.

What confirms the diagnosis at birth?

The orogastric tube does not reach the stomach and is seen coiled in the esophageal pouch on X-ray.

Which association should be looked for in a newborn with tracheoesophageal fistula?

The VACTERL association: vertebral, anal, cardiac, tracheoesophageal, renal and limb anomalies.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of embryology

Educational content on embryonic development; not a guide to prenatal diagnosis or to medicines in pregnancy and no substitute for a health professional's advice. No doses are given.

Sources: Esophageal Atresia | Birth Defects | CDC (Centers for Disease Control and Prevention, 2026); Esophageal atresia/tracheoesophageal fistula: MedlinePlus Genetics (MedlinePlus, U.S. National Library of Medicine, 2015); Langman's Medical Embryology, 13th ed., ch. 14: Respiratory System (Wolters Kluwer, 2015).

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