Malrotation with midgut volvulus

I woke up at 3am from a call to refer a baby with persistent yellowish vomiting for the past four days, now in with dehydration.

It was a lengthy case presentation for a 3am referral to a sleepy person. Being the good listener I am I didn't cut in her enthusiastic case presentation but I did wonder where her energy came from. What woke me up was when she said AXR no gaseous bowel seen. Then she said "we're thinking of pyloric stenosis."

That was anti climatic. Now I had to say something. "How old is this baby again?"

"Day 12."

"AXR is gasless?"

"Yah, I can send you the xray."

"What's the baby's name? I'll go see the babe."

By the time I came, baby looked less active but still buas macam ape cabut Ryle's tube tiga kali sudah. The nurse reinserted and aspirated his Ryle's tube, then showed to me a satisfying 10ml blob of thick greenish aspirate. Then I found the AXR. Yep, gasless.

I grinned to myself. Will they be happy with my catch because we like to cut babies, or will they tease me for picking up cases again. This week we've been having a field day opening neonates up.

Clinically it looked like a malrotation with midgut volvulus. I hope the bowel survive this few more hours.

"Mana mama baby ni?"

"Balik. Sebab rooming in tiada kosong."

"Boleh panggil dia? Macam nak operate esok pagi la."

And guess who was right?