A full-term female baby born to a healthy G3P3 female via SVD complicated by 2 vessel cord and meconium.  Prenatal ultrasound has revealed a lumbosacral defect, which was confirmed as myelomeningocele at birth.  Neurosurgery consulted, and patient posted for repair four hours later.   NICU attempted NG tube, however chest X-Ray demonstrated coiling in the proximal esophagus, suggestive of blind pouch versus tracheoesophageal fistula. This case was a rare example of multiple combined central lesions, which resulted in complicated anesthesia care.  It was a good example of difficulty that can result from abnormal physiology, anatomy of the airway, and spinal cord and how to manage it.

A safe surgical and anesthesia approach in a full term baby girl with a rare presentation of combination: myelomeningocele and unknown anatomy of tracheoesophageal fistula