Tracheo-esophageal fistula(TEF) is a common congenital anomaly of the respiratory tract. A preterm baby boy was evaluated immediately after birth for absence of gastric bubble on antenatal scan. Subsequent abdominal X-rays showed coiling of the NG tube with no stomach gas shadow , which led to suspicion of esophageal atresia(EA) Type-A. The neonate underwent open gastrostomy on D2 of life. After establishing gastrostomy feeding, he developed neonatal respiratory distress, which prompted an UGI contrast study . This showed the appearance of Type-C TEF with suspected duodenal atresia(DA) due to paucity of abdominal gas. On D5 of life, Type-C TEF repair was performed along with exploratory laparotomy to exclude duodenal atresia. The distal stomach and duodenum were visualised with no evidence of duodenal atresia. To further exclude duodenal atresia, an endoscope and laparoscope were passed through the gastrostomy on D12 and D17 of life and found an intact lumen, with uspicion of a kink at the D1 level or possible gastroparesis, leading to advancement of the NG tube through the duodenum. The neonate was gradually weaned from ventilation and commenced on nasoduodenal bolus feeding. Once full feeding was tolerated, gastrostomy feeding was slowly reestablished, because of cleft palate. He was discharged on D45 of life. Absence of gastric bubble on antenatal scan and absent or minimal gas-filled gastrointestinal tract on chest radiographs of the neonate will not exclude Type-C TEF. Be mindful to do bronchoscopy and do repeated abdominal x-rays to exclude Type-C TEF and confirm before performing repair of Type-A oesophageal atresia.