This case report presents a rare case of right-sided congenital diaphragmatic hernia (CDH) with concurrent oesophageal atresia and tracheo-oesophageal fistula (OA/TOF) in a premature baby. CDH was diagnosed antenatally and OA/TOF discovered within the first hours of life. We summarise the immediate postnatal and surgical care highlighting the difficult surgical decision making in such cases. Similar to most centres, any patient with a diaphragmatic hernia delivered or brought into our centre is by default deferred for surgery to allow pulmonary vascular resistance to fall and maximise a patient’s ventilatory capacity for anaesthesia –typically within the first week of life. On the other hand, there is normally an urgency to divide a trachea-oesophageal fistula to prevent gastric and intestinal gaseous distension which cannot be vented via a nasogastric tube. There exists very limited reporting on the conditions combine, while both separately already display high morbidity and mortality rates. Hence, when our teams were presented with this case, we found it helpful at each stage to highlight the surgical priority and make that clear to neonatal and anaesthetic teams. Whilst we recognise this is a single case study it adds to the sparse literature on right-sided CDH with OA/TOF and supports the principle of well thought out and planned staged repair. We think this contributed towards the survival in this case in a patient population with well reported poor survival. In the first 6-12 months post discharge the child has had some ongoing morbidity. Tracheo-bronchio-malacia and recurrent chest infections due to collapse / consolidation led to the need for overnight non-invasive ventilation which has subsequently been slowly weaned. The child has transitioned to full oral feeds with no ongoing need for gastrostomy. At 18 months of age the child did require a subsequent laparotomy for a small recurrence of the diaphragmatic hernia with a small bowel loop in the chest. This was repaired primarily, and the child remains well at 2 years of age.

Emile Crouzen is a dedicated Resident Medical Officer with experience in the United Kingdom and a current focus on pediatric medicine and neonatology in New Zealand. His work reflects a strong commitment to providing exceptional care for children and newborns, showcasing his expertise and passion in these specialized fields.