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To the Editor:The incidence of esophageal atresia (EA) along with tracheoesophageal fistula (TEF) is approximately 1/3000 in newbs[1] A large population study revealed that 46％ of patients with TEF/EA had at least one of the other vertebral,anal,cardiac,tracheal,esophageal,renal,and limb (VACTERL) malformations.[2] Duodenal obstruction has an incidence of 1/7000 live births and can be caused by duodenal atresia (DA) or annular pancreas (AP).[3] AP is an uncommon congenital anomaly,and duodenal obstruction most commonly presents in the infancy or early childhood of patients.[4] The incidence of DA combined with EA varies between 3％ and 6％,[5] and DA combined with EA is often associated with significant morbidity and mortality.[6] Combined presence of EA/TEF and duodenal obstruction always lead to several management challenges,such as determination of the treatment order and the treatment patt (together or staged).[7] There is no relevant surgical strategy or literature for the complicated cases of combined digestive tract atresia in different parts of the chest and abdomen.The management protocol for this combination of anomalies is not well defined and controversial.A gastrostomy tube placed first for gastric decompression and staged repair (ideally within days,weeks) have been suggested by most surgeons.[8]