VACTERAL syndrome is associated with -

Ans. is 'c' i.e., Tracheo-esophageal fistula Tracheoesophageal fistula (TEF) and esophageal atresiao Esophageal atresia is the most common congenital anamoly of the esophagus. More than 90% are associated with tracheoesophageal fistula.o The most common variety is the one where upper part of esophagus ends blindly and the lower part is connected to trachea by a fistula. TEF should be suspected in all cases of hydroamnion.o There may be associated anomalies - VACTERL (vertebral, anorectal, cardiac, tracheal, esophageal, renal, radial, limb) syndrome.Classification of tracheoesophageal fistula (TEF)o TEF is classified into five types based on presence of esophageal atresia and location of fistula:-1) Type A: There is esophageal atresia without TEF. There is no gas in abdomen. It is 2nd most common type.2) Type B: There is proximal TEF. There is no gas in abdomen.3) Type C: There is proximal esophageal atresia with distal TEF. Gas in abdomen is present. It is most common.4) Type D: Both proximal and distal fistula are present. Gas in abdomen is present. It is least common.5) Type E: Isolated TEF (H or N type) is there.Clinical featureso Neaonates present with frothing, excessive drooling, coughing and cyanosis with feeding. This is followed by respiratory distress. Newborn regurgitates of its first and subsequent feeds.Diagnosiso Inability to pass a nasogastric tube confirms the diagnosis of TEF.o Lateral chest X-ray shows a lucent proximal pouch that may displace trachea anteriorlyo X-ray abdomen shows gas in stomach in commonest variety type-C TEF.