Bilious vomiting and intestinal obstruction — formative SAQs

SAQ 1 — The neonate who suddenly vomits green (10 marks, 15 minutes)

A 4-day-old term baby who has fed and stooled normally suddenly vomits a large amount of bright green fluid. On arrival he is alert with a soft, only mildly full abdomen and normal observations. ^[1]

a) State the diagnosis that must be excluded first and explain, using the anatomy, why it is so dangerous. (3 marks) ^{[2] [12]}

b) Outline your immediate resuscitation and the single most useful confirmatory investigation, and state when you would bypass imaging entirely. (4 marks) ^{[1] [6]}

c) Describe the key steps of the definitive operation for a confirmed midgut volvulus. (3 marks) ^{[12] [2]}