Intussusception — branching viva

Opening — framing the problem

The examiner begins: a previously well seven-month-old has had four hours of episodes of screaming, going pale and drawing up the knees, with a drowsy interval between them, and has vomited twice. Talk me through your approach. ^[1]

I would frame this as intussusception, the commonest cause of bowel obstruction in an infant, and recognise the rhythmic pattern of peristalsis-driven colic as itself the key clue. My priorities would be to assess and resuscitate, to confirm the diagnosis with ultrasound, and to involve the surgeon and radiologist early, because early enema reduction is curative in most and delay risks the bowel. ^{[1] [2]}