Case #18
Subject:
Embryology
A newborn is brought to the physician because of vomiting uncurdled milk after feeding, despite
suckling avidly. The mother had polyhydramnios during her pregnancy.
Which of the following is the most likely developmental defect in this child?
A. Annular pancreas
B. Ileal divelticulum
C. Omphalocele
D. Pyloric stenosis
E. Tracheoesophageal fistula
Medcloud™
Case #18
Subject:
Embryology
Medcloud™
Case #18
Subject:
Embryology
The correct answer is E Tracheoesophageal fistula
The respiratory diverticulum forms as an evagination of the foregut. The trachea then becomes
separated from the esophagus by formation of the tracheoesophageal septum. Abnormalities in
this septation lead to a tracheoesophageal fistula (TEF). About 90% of cases of TEF involve a
proximal cul-de-sac in the esophagus, with the distal esophagus forming a fistula with the trachea.
As soon as the proximal esophagus fills with milk, the child will vomit. Because the milk never
reaches the stomach, the vomitus is not curdled, as it is undigested. Maternal polyhydramnios is
caused by a failure of the passage of swallowed amniotic fluid into the gastrointestinal tract, where
it would normally be absorbed. The esophageal fistula into the trachea will also cause severe lung
irritation. TEF can be corrected surgically.
Medcloud™
Case #19
Subject:
Embryology
A 2-week-old newborn is brought to the physician because of vomiting. Physical examination shows
a small mass about the size of an olive in the epigastric area. Which of the following conditions is
this child most likely exhibiting?
A. Biliary stenosis
B. Duodenal atresia
C. Non-bilious vomiting
D. Pancreas divisum
E. Pancreatitis
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