Colorectal Surgery — MCQs

Q: All of the following are true regarding pilonidal sinus except:

Seen predominantly in women. ***Seen predominantly in women*** - Pilonidal sinus is **more prevalent in men** than in women, with a male-to-female ratio of about 3–4:1. - This higher incidence in males is often attributed to greater hairiness and occupational factors. *Most commonly occurs in sacrococcygeal region* - This is a **TRUE statement** - the sacrococcygeal region is the **most common site** for pilonidal sinus (>90% of cases). - While less commonly, pilonidal sinuses can also occur in other hairy areas such as the periumbilical region, axilla, and scalp (particularly in barbers). *Tendency for recurrence* - Pilonidal sinuses have a **high tendency for recurrence**, even after surgical intervention, especially with inadequate excision or conservative management. - Factors contributing to recurrence include presence of **remaining hair follicles** or insufficient removal of sinus tracts. *Obesity is a risk factor* - **Obesity** is a recognized risk factor for the development of pilonidal sinus. - Increased weight can lead to deeper gluteal clefts, increased sweating, and friction, which promote hair follicle damage and foreign body inflammatory reactions.

Q: Procedure of choice in ulcerative colitis with acute perforation is

Total colectomy and ileostomy. ***Total colectomy and ileostomy*** - **Acute perforation** in ulcerative colitis is a life-threatening emergency requiring immediate and definitive surgical management. - **Total colectomy** removes the diseased colon, preventing further perforation and systemic toxicity, with an ileostomy providing fecal diversion. *Defunctioning ileostomy* - A defunctioning ileostomy alone would not address the actively perforated and inflamed colon, leaving the source of sepsis intact. - This procedure leads to potentially fatal **peritoneal contamination** and ongoing inflammation. *Closure of perforation* - Direct closure of a colonic perforation in the context of acute ulcerative colitis is generally contraindicated due to the **fragile, inflamed, and friable bowel tissue**, which is prone to dehiscence. - This approach carries a high risk of **re-perforation** and persistent sepsis. *Proximal diversion colostomy* - A proximal diversion colostomy, similar to a defunctioning ileostomy, fails to remove the diseased and perforated segment of the colon. - It would not prevent the continued leakage of bowel contents from the perforation site into the **abdominal cavity**, leading to severe peritonitis.

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Diverticular Disease

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Fecal Incontinence

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Enhanced Recovery After Colorectal Surgery

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