In my first call week post, I got two comments (from 
I have succeeded at explaining medical conditions to the general public a few times but with pediatric surgery, it is either I do not understand this area well enough or developmental disorders are hard to understand. I will do my best to keep things simple and also not bore you with too much information.
If you recall from my first call post, I said
Even though now I am few days from finishing this unit and I realize that what I am complaining about in this week was actually nothing to complain about when compared to the call week I just finished.
In this call we had:
All this was before the nation's doctors went on strike on the 2nd of August.
So I will take each case and explain what they are one after the other.
In Intussiception the bowel abnormally slides into itself sort of like a telescope does. Unlike in an actual telescope where light is made to pass through the tiny opening between the pipes, the bowels carry high viscosity food and can get obstructed.
This can lead to a backflow of the intestines content leading sooner or later to vomiting as the food can not be pushed past the tiny space in the lumen of the bowels.
There is abdominal distension as the intestines continue to force the food down the intestinal tract.
Because the bowels are being stretched alongside other viscera, pain is also a symptom expressed by these patients. Read more about intussusception here
The cause is usually due to an enlarged lymph node.
We had a call around 6 pm while the call was going smoothly on Monday the 26th of July asking us to review a 5-month-old patient who had abdominal distention, abdominal pain, and vomiting.
I ensured that before were being called the baby had already been stabilized by the pediatric team before we came.
In about 30 minutes, I received another call from the same house officer about a similar case happening before we arrived.
We planned to take both patients into the theatre as soon as possible. While we collected history and did tests on the patient, we received another consult for the third patient.
This was around 8 pm, we were just rounding up seeing the first patient and were preparing them for theatre.
We ended up cutting off the parts of the intestine that had behaved abnormally and attaching normal parts.
A child can be born with bowels that do not have valves or are closed. In the case of esophageal atresia, a part of the bowel is closed and the closed part of the bowel is the esophagus.
Read more here
When a part of the gut such as the esophagus is closed, it can cause symptoms like vomiting, coughing as feeds pass to the windpipe, and weight loss as the feeds do not reach the stomach.
While we were reviewing the second patient by 8 pm, the pediatricians slipped in the consult for this patient into my pocket. At this point, I was bracing myself up for a difficult week already. The registrar of my team was ill and I was beginning to do more than I typically do as a medical house officer.
This case was not operated on until necessary X-Ray investigations were done. After which we confirmed that it was in fact esophageal atresia.
The patient was a 2 week old female and it was a miracle that she had survived that long considering she had not been receiving anything by mouth. I didn't gather all the necessary information, but she may likely have been admitted into the Special Care Baby Unit of another hospital
When we were almost done reviewing this patient a newborn was rushed into the Children's Emergency room. He had his intestines visible outside his body through a huge gap in his abdomen, this is Garochisis.
I already described the condition above as it typically presents.
In addition, there will be malabsorption due to the irritation of the exposed bowels.
When we went to review the patient on Tuesday, he had been stabilized by the pediatric Special Care Baby Unit. He was under a radiant warmer while receiving fluid and pain medication.
The treatment for Gatrochesis is very interesting. The surgeon creates a bag that contains the bowels called a silo.
Gradually the bowels are put back into the gut as the silo is suspended and the gut is pushed back into the abdominal cavity.
The silo will be gradually constricted while pushing the gut into the abdomen.
The baby's back is not supposed to touch the crib's bed so that the traction can pull the skin and other tissue.
After the gut is put back gradually the abdomen is closed.
The next case was a case of Perforated viscus. I can't remember what the cause was, but I had pictures of the area that was perforated on my phone.
It was around the transverse colon. That is the part of the large intestine that runs on the transverse plane.
Some of the possible causes of a perforated viscus in a neonate as presented in this case would be Necrotising enterocolitis.
According to NCBI, it is a cause of 42% of cases of a perforated viscus. Read that here
By this time I was already tired from all the cases flooding. In the date from the pictures, I took show **** which was on a...
The appendicitis case came on Thursday when we were almost done with the call. Friday is the unit's clinic and I had fallen ill.
I discussed the management of appendicitis already in another post.
Check it out here.
The cases that were booked for the next Monday immediately after the call were:
This concludes my post about my calls in pediatric surgery.
