General Surgery — MCQs
On this page
A 68-year-old man undergoes a right hemicolectomy for a caecal adenocarcinoma. Histology reports a pT3 N2b M0 tumour with microsatellite instability-high (MSI-H) status confirmed. All twelve harvested lymph nodes are positive for metastatic disease. The tumour shows poor differentiation with prominent lymphocytic infiltration. Which of the following statements regarding his prognosis and management is most accurate?
A 33-year-old woman at 20 weeks gestation presents with a 22-hour history of right lower abdominal pain, nausea, and fever of 37.9°C. She reports the pain initially started periumbilically but has now localized to the right lower quadrant. On examination, she has right iliac fossa tenderness with guarding. Blood tests show WCC 15.8 × 10⁹/L and CRP 62 mg/L. What is the most appropriate initial imaging investigation?
A 58-year-old man with a newly diagnosed T3 N0 M0 adenocarcinoma of the descending colon undergoes an uncomplicated laparoscopic left hemicolectomy with clear resection margins. Histology confirms moderately differentiated adenocarcinoma with no lymphovascular invasion. Twenty-two lymph nodes were examined, all negative. His postoperative recovery is unremarkable. What is the most appropriate adjuvant management?
What is the inheritance pattern of familial adenomatous polyposis (FAP)?
A 70-year-old woman undergoes an elective sigmoid colectomy for a T2 N0 M0 sigmoid adenocarcinoma. She has a history of type 2 diabetes mellitus, hypertension, and previous abdominal hysterectomy. On postoperative day 5, she develops increasing abdominal pain and distension. Her observations show temperature 38.4°C, heart rate 110 bpm, blood pressure 105/65 mmHg. Abdominal examination reveals generalized peritonism. Blood tests show WCC 18.5 × 10⁹/L and CRP 245 mg/L. What is the most likely diagnosis?
A 42-year-old man presents with a 30-hour history of right iliac fossa pain. He is haemodynamically stable with a temperature of 37.8°C, heart rate 88 bpm, and blood pressure 128/78 mmHg. His Alvarado score is 6. Blood tests show WCC 11.2 × 10⁹/L and CRP 45 mg/L. What is the most appropriate next investigation?
A 48-year-old man presents with a painless left groin swelling. On examination, there is a 3cm lump below and lateral to the pubic tubercle that does not extend into the scrotum. The lump is reducible and there is a palpable cough impulse. What is the most likely diagnosis?
During laparoscopic appendicectomy in a 35-year-old woman, the surgeon encounters an inflamed appendix with a firm 3cm mass at the base. The caecal wall appears thickened and indurated. The rest of the colon appears macroscopically normal. What is the most appropriate intraoperative management?
A 65-year-old man with a T3 N1 M0 adenocarcinoma of the upper rectum (12cm from anal verge) undergoes an anterior resection with total mesorectal excision. Histology confirms complete excision with clear circumferential resection margin (CRM) of 4mm. There is extramural vascular invasion present. Four of twelve lymph nodes are positive for metastatic disease. What is the appropriate adjuvant treatment recommendation?
A 60-year-old man undergoes emergency repair of a strangulated right inguinal hernia. Intraoperatively, a segment of small bowel within the hernia sac appears dusky but after reduction and observation for 10 minutes, it shows improved colour with visible peristalsis. However, there remains a 2cm area of questionable viability without obvious perforation. What is the most appropriate intraoperative decision?
General Surgery UK Medical PG Practice Questions and MCQs
Question 31: A 68-year-old man undergoes a right hemicolectomy for a caecal adenocarcinoma. Histology reports a pT3 N2b M0 tumour with microsatellite instability-high (MSI-H) status confirmed. All twelve harvested lymph nodes are positive for metastatic disease. The tumour shows poor differentiation with prominent lymphocytic infiltration. Which of the following statements regarding his prognosis and management is most accurate?
- A. MSI-H status confers a worse prognosis than microsatellite stable (MSS) tumours at the same stage
- B. MSI-H tumours are less responsive to 5-FU based chemotherapy compared to MSS tumours (Correct Answer)
- C. The presence of MSI-H indicates he likely has Lynch syndrome and genetic counselling should be offered
- D. MSI-H status is typically associated with left-sided colon cancers
- E. The lymphocytic infiltration suggests immunosuppression and poor prognosis
Explanation: ***MSI-H tumours are less responsive to 5-FU based chemotherapy compared to MSS tumours*** - Retrospective studies indicate that tumours with **microsatellite instability-high (MSI-H)** status do not derive the same survival benefit from **5-Fluorouracil (5-FU) monotherapy** as microsatellite stable (MSS) tumours. - In stage III disease, **oxaliplatin-based regimens** (like FOLFOX) are preferred as they overcome the relative chemoresistance of MSI-H status. *MSI-H status confers a worse prognosis than microsatellite stable (MSS) tumours at the same stage* - Paradoxically, **MSI-H status** is associated with a **better stage-for-stage prognosis** and improved overall survival compared to MSS tumours. - This improved survival is partly due to the high **mutational burden** attracting a robust immune response. *The presence of MSI-H indicates he likely has Lynch syndrome and genetic counselling should be offered* - While all **Lynch syndrome** cancers are MSI-H, approximately 12% of colorectal cancers are **sporadic MSI-H** due to **MLH1 promoter hypermethylation**. - Further testing for **BRAF mutations** or MLH1 methylation is required before confirming a high likelihood of a germline Lynch syndrome mutation. *MSI-H status is typically associated with left-sided colon cancers* - MSI-H tumours are famously associated with **right-sided colon cancers** (caecum and ascending colon), as seen in this patient. - They often present with specific histological features like **mucinous differentiation** and a **medullary growth pattern**. *The lymphocytic infiltration suggests immunosuppression and poor prognosis* - **Prominent lymphocytic infiltration** (Crohn's-like reaction) is a hallmark of MSI-H tumours and signifies an **active host immune response**. - This feature is actually a marker of **good prognosis** and is a key reason for the potential success of **immunotherapy** (checkpoint inhibitors) in these patients.
Question 32: A 33-year-old woman at 20 weeks gestation presents with a 22-hour history of right lower abdominal pain, nausea, and fever of 37.9°C. She reports the pain initially started periumbilically but has now localized to the right lower quadrant. On examination, she has right iliac fossa tenderness with guarding. Blood tests show WCC 15.8 × 10⁹/L and CRP 62 mg/L. What is the most appropriate initial imaging investigation?
- A. CT abdomen and pelvis with intravenous contrast
- B. Transabdominal and transvaginal ultrasound (Correct Answer)
- C. MRI abdomen and pelvis without contrast
- D. Plain abdominal radiograph
- E. No imaging required; proceed to diagnostic laparoscopy
Explanation: ***Transabdominal and transvaginal ultrasound***- **Ultrasound (US)** is the **first-line** imaging modality for suspected **acute appendicitis** in pregnant patients because it avoids **ionizing radiation** exposure to the fetus.- It is highly useful in the **second trimester** to assess for appendiceal inflammation while simultaneously ruling out **gynecological** or **obstetric** causes of right lower quadrant pain.*CT abdomen and pelvis with intravenous contrast*- This modality involves significant **ionizing radiation**, which should be avoided in pregnancy due to risks of **fetal teratogenicity** and childhood malignancies.- It is typically reserved as a last resort if both **ultrasound and MRI** are non-diagnostic and the clinical risk of missed appendicitis is high.*MRI abdomen and pelvis without contrast*- **MRI** is the preferred **second-line** investigation when ultrasound is inconclusive, as it provides excellent soft tissue detail without radiation.- While highly accurate, it is not the initial step due to higher **costs**, longer scan times, and limited immediate availability compared to ultrasound.*Plain abdominal radiograph*- This imaging has **extremely low sensitivity** for diagnosing appendicitis and provides no useful diagnostic information for this presentation.- It exposes the fetus to **unnecessary radiation** without aiding in the differentiation of causes for abdominal pain.*No imaging required; proceed to diagnostic laparoscopy*- Proceeding directly to surgery without imaging increases the rate of **negative appendectomies**, which carries risks of **preterm labor** and fetal loss.- Preoperative imaging is standard in pregnancy to confirm the diagnosis and minimize **surgical morbidity** unless the patient is hemodynamically unstable.
Question 33: A 58-year-old man with a newly diagnosed T3 N0 M0 adenocarcinoma of the descending colon undergoes an uncomplicated laparoscopic left hemicolectomy with clear resection margins. Histology confirms moderately differentiated adenocarcinoma with no lymphovascular invasion. Twenty-two lymph nodes were examined, all negative. His postoperative recovery is unremarkable. What is the most appropriate adjuvant management?
- A. Adjuvant chemotherapy with FOLFOX or CAPOX for 6 months
- B. Adjuvant radiotherapy for 5 weeks
- C. No adjuvant treatment; proceed directly to surveillance (Correct Answer)
- D. Adjuvant 5-FU monotherapy for 6 months
- E. Chemoradiotherapy for 5 weeks
Explanation: ***No adjuvant treatment; proceed directly to surveillance*** - This patient has **low-risk Stage IIA colon cancer (T3 N0 M0)**, characterized by the absence of positive lymph nodes and other high-risk features like lymphovascular invasion or poorly differentiated histology. - For low-risk Stage II colon cancer, adjuvant chemotherapy provides a negligible survival benefit (<5%), making **surveillance** the appropriate standard of care to avoid unnecessary toxicity. *Adjuvant chemotherapy with FOLFOX or CAPOX for 6 months* - These combination regimens, typically involving **oxaliplatin**, are the standard for **Stage III (node-positive)** colon cancer due to their proven survival benefit. - The significant toxicities, particularly **peripheral neuropathy** from oxaliplatin, outweigh the minimal to no benefit in low-risk Stage II colon cancer. *Adjuvant radiotherapy for 5 weeks* - Adjuvant radiotherapy is generally **not indicated for colon cancer** because of the mobile nature of the colon and the high risk of damaging surrounding small bowel. - This treatment modality is primarily reserved for **rectal cancer**, where its benefits in local control and recurrence reduction are well-established. *Adjuvant 5-FU monotherapy for 6 months* - While 5-FU monotherapy has been studied in Stage II colon cancer, the observed benefit, as shown in trials like **QUASAR**, is very small and generally not considered clinically meaningful for low-risk patients. - It might be considered for select **high-risk Stage II** patients who cannot tolerate oxaliplatin, but the patient in this scenario is low-risk. *Chemoradiotherapy for 5 weeks* - Combined chemoradiotherapy is a standard treatment for **locally advanced rectal cancer** (neoadjuvant or adjuvant) to improve local control and survival. - It has **no established role** in the routine management of adenocarcinoma of the descending colon, regardless of stage.
Question 34: What is the inheritance pattern of familial adenomatous polyposis (FAP)?
- A. Autosomal dominant (Correct Answer)
- B. Autosomal recessive
- C. X-linked dominant
- D. X-linked recessive
- E. Mitochondrial inheritance
Explanation: ***Autosomal dominant*** - **Familial adenomatous polyposis (FAP)** is caused by a germline mutation in the **APC gene** on chromosome **5q21**, which follows an **autosomal dominant** inheritance pattern. - This means a single copy of the mutated gene is sufficient to cause the disease, and affected individuals have a **50% chance** of passing it to their offspring. *Autosomal recessive* - **Autosomal recessive** inheritance requires two copies of the mutated gene; however, classic FAP is linked to a **dominant** transmission of the **APC mutation**. - While **MUTYH-associated polyposis (MAP)** is an autosomal recessive polyposis syndrome, FAP itself does not follow this pattern. *X-linked dominant* - FAP involves an **autosome (chromosome 5)** rather than sex chromosomes, meaning it affects **males and females equally**. - **X-linked dominant** disorders would show a vertical transmission pattern that differs based on the **parent's gender**, which is not seen in FAP. *X-linked recessive* - **X-linked recessive** disorders primarily affect **males**, whereas FAP occurs with equal frequency and severity in both sexes. - Since the **APC gene** is located on a **non-sex chromosome**, the inheritance cannot be X-linked. *Mitochondrial inheritance* - This pattern involves mutations in **mitochondrial DNA** inherited exclusively from the **mother**; FAP is a **nuclear DNA** disorder. - Diseases with this pattern often involve high-energy organs like the brain and muscles, unlike the **colonic adenomas** seen in FAP.
Question 35: A 70-year-old woman undergoes an elective sigmoid colectomy for a T2 N0 M0 sigmoid adenocarcinoma. She has a history of type 2 diabetes mellitus, hypertension, and previous abdominal hysterectomy. On postoperative day 5, she develops increasing abdominal pain and distension. Her observations show temperature 38.4°C, heart rate 110 bpm, blood pressure 105/65 mmHg. Abdominal examination reveals generalized peritonism. Blood tests show WCC 18.5 × 10⁹/L and CRP 245 mg/L. What is the most likely diagnosis?
- A. Paralytic ileus
- B. Intra-abdominal collection/abscess
- C. Anastomotic leak (Correct Answer)
- D. Wound infection
- E. Small bowel obstruction from adhesions
Explanation: ***Anastomotic leak*** - This patient's presentation on **postoperative day 5** with increasing abdominal pain, distension, fever, tachycardia, hypotension, and especially **generalized peritonism**, is highly indicative of an anastomotic leak. - Markedly elevated inflammatory markers (**WCC 18.5 × 10⁹/L, CRP 245 mg/L**) confirm a severe systemic inflammatory response consistent with **fecal peritonitis** from a surgical emergency. *Paralytic ileus* - While causing abdominal distension, **paralytic ileus** typically lacks **peritonism** and severe systemic inflammatory signs like high fever, marked leukocytosis, and hypotension. - It usually presents earlier in the postoperative course (days 1-3) and is characterized by absent or reduced bowel sounds. *Intra-abdominal collection/abscess* - An **intra-abdominal collection** or **abscess** often presents with fever and raised inflammatory markers, but typically causes **localized abdominal pain** and tenderness, not generalized peritonism. - The profound systemic signs and diffuse peritonitis point to a widespread contamination rather than a contained collection. *Wound infection* - **Wound infection** is characterized by localized signs such as **erythema**, warmth, tenderness, and potentially pus at the incision site. - It does not explain the **generalized peritonism**, severe abdominal distension, or the degree of systemic compromise observed in this patient. *Small bowel obstruction from adhesions* - **Small bowel obstruction** typically presents with **colicky abdominal pain**, vomiting, abdominal distension, and altered bowel sounds (e.g., high-pitched). - Unless complicated by **strangulation** or **perforation**, it would not usually cause **generalized peritonism** or the severe septic picture with hypotension and diffuse peritonitis.
Question 36: A 42-year-old man presents with a 30-hour history of right iliac fossa pain. He is haemodynamically stable with a temperature of 37.8°C, heart rate 88 bpm, and blood pressure 128/78 mmHg. His Alvarado score is 6. Blood tests show WCC 11.2 × 10⁹/L and CRP 45 mg/L. What is the most appropriate next investigation?
- A. CT abdomen and pelvis with intravenous contrast (Correct Answer)
- B. Proceed directly to diagnostic laparoscopy
- C. Ultrasound of the abdomen and pelvis
- D. MRI abdomen and pelvis
- E. Plain abdominal radiograph
Explanation: ***CT abdomen and pelvis with intravenous contrast*** - In an adult male with an **intermediate Alvarado score (6)**, cross-sectional imaging is required to confirm the diagnosis and prevent **negative appendicectomy**. - **CT with IV contrast** is the gold standard for adults due to its high **sensitivity (95%)** and specificity, helping to identify alternative pathology or complications like abscesses. *Proceed directly to diagnostic laparoscopy* - Direct surgical intervention without imaging is generally reserved for patients with high probability (**Alvarado score ≥ 7**) or those showing signs of **peritonitis**. - Moving straight to surgery in intermediate cases increases the risk of an **unnecessary invasive procedure** if another condition is causing the pain. *Ultrasound of the abdomen and pelvis* - **Ultrasound** is highly operator-dependent and has a lower sensitivity in adults compared to CT, often limited by **bowel gas** or body habitus. - It is the first-line investigation in **children and pregnant women** to avoid ionising radiation but is not preferred for adult males. *MRI abdomen and pelvis* - **MRI** is highly accurate but is limited by **high cost**, longer acquisition times, and lack of universal around-the-clock availability in emergency departments. - It is primarily indicated as a second-line investigation in **pregnant patients** when ultrasound is inconclusive. *Plain abdominal radiograph* - **Plain X-rays** have very low sensitivity for diagnosing appendicitis and rarely show specific signs like a **calcified appendicolith**. - They are inappropriate in this clinical scenario as they do not provide sufficient detail to confirm or exclude **acute appendicitis**.
Question 37: A 48-year-old man presents with a painless left groin swelling. On examination, there is a 3cm lump below and lateral to the pubic tubercle that does not extend into the scrotum. The lump is reducible and there is a palpable cough impulse. What is the most likely diagnosis?
- A. Direct inguinal hernia
- B. Femoral hernia (Correct Answer)
- C. Indirect inguinal hernia
- D. Saphena varix
- E. Inguinal lymphadenopathy
Explanation: ***Femoral hernia*** - A femoral hernia is anatomically defined by its position **below and lateral** to the **pubic tubercle**, exiting through the femoral canal. - It presents as a groin lump that often has a **cough impulse** and may be reducible, though it carries a high risk of **incarceration** due to narrow canal boundaries. *Direct inguinal hernia* - Located **above and medial** to the pubic tubercle, arising through a defect in the **Hesselbach's triangle** (posterior wall of the inguinal canal). - These are typically seen in older men and rarely descend into the **scrotum** compared to indirect hernias. *Indirect inguinal hernia* - Positioned **above and medial** to the pubic tubercle, exiting the abdominal cavity via the **deep inguinal ring**. - Frequently extends into the **scrotum** or labia majora and is the most common groin hernia in both sexes. *Saphena varix* - A dilation of the **saphenous vein** at the saphenofemoral junction that may disappear immediately upon lying down. - It characteristically presents with a unique **fluid thrill** (Cruveilhier’s sign) rather than a simple cough impulse. *Inguinal lymphadenopathy* - Typically presents as multiple, **firm, non-reducible** nodules rather than a single soft reducible swelling. - Lacks a **cough impulse** and is often associated with distal infection, malignancy, or systemic illness.
Question 38: During laparoscopic appendicectomy in a 35-year-old woman, the surgeon encounters an inflamed appendix with a firm 3cm mass at the base. The caecal wall appears thickened and indurated. The rest of the colon appears macroscopically normal. What is the most appropriate intraoperative management?
- A. Complete the appendicectomy and send specimen for urgent histology
- B. Convert to open procedure and perform right hemicolectomy (Correct Answer)
- C. Abandon the procedure and arrange interval colonoscopy
- D. Perform appendicectomy and take multiple biopsies from the caecal wall
- E. Convert to open, perform appendicectomy with wedge excision of caecal mass
Explanation: ***Convert to open procedure and perform right hemicolectomy*** - A **3cm firm mass** at the **base of the appendix** with **thickened and indurated caecal wall** is highly suspicious for malignancy (e.g., appendiceal or caecal adenocarcinoma). - **Right hemicolectomy** is the appropriate oncological resection for such a mass to ensure **negative margins** and adequate **lymph node dissection**. *Complete the appendicectomy and send specimen for urgent histology* - Simple **appendicectomy** is insufficient for a large (3cm) mass involving the **caecal wall**, as it would likely leave **residual disease**. - This approach would necessitate a **second major operation** for definitive oncological resection after the histology confirms malignancy. *Abandon the procedure and arrange interval colonoscopy* - **Abandoning the procedure** leaves the highly suspicious mass untreated, risking **progression of malignancy** and potential complications. - While a **colonoscopy** can provide further information, it does not replace the need for immediate and **definitive surgical management** of a visible, palpable mass. *Perform appendicectomy and take multiple biopsies from the caecal wall* - Relying on **biopsies** from a large, indurated mass carries a risk of **sampling error** and can delay definitive treatment, especially if the initial biopsy is non-diagnostic. - Performing only an **appendicectomy** with biopsies does not provide **oncological clearance** for a mass involving the caecum. *Convert to open, perform appendicectomy with wedge excision of caecal mass* - A **wedge excision** of a 3cm mass with caecal involvement is generally inadequate for suspected malignancy, as it may not achieve **oncologically clear margins** or appropriate **lymph node harvest**. - This approach is typically reserved for **smaller, benign lesions** or very low-grade localized tumors, which is not indicated here given the mass size and caecal involvement.
Question 39: A 65-year-old man with a T3 N1 M0 adenocarcinoma of the upper rectum (12cm from anal verge) undergoes an anterior resection with total mesorectal excision. Histology confirms complete excision with clear circumferential resection margin (CRM) of 4mm. There is extramural vascular invasion present. Four of twelve lymph nodes are positive for metastatic disease. What is the appropriate adjuvant treatment recommendation?
- A. Adjuvant chemotherapy with FOLFOX or CAPOX for 6 months (Correct Answer)
- B. No adjuvant treatment required given clear resection margins
- C. Long-course chemoradiotherapy followed by chemotherapy
- D. Short-course radiotherapy followed by chemotherapy
- E. Adjuvant radiotherapy alone for 5 weeks
Explanation: ***Adjuvant chemotherapy with FOLFOX or CAPOX for 6 months*** - This patient has **Stage III rectal cancer** (pT3 N2a given 4 positive lymph nodes) with high-risk features like **extramural vascular invasion (EMVI)**, indicating a high risk of systemic recurrence. - For **upper rectal cancers** (12cm from anal verge) that have undergone a successful **total mesorectal excision (TME)** with clear margins, adjuvant systemic chemotherapy is the standard of care to reduce the risk of distant metastasis. *No adjuvant treatment required given clear resection margins* - While **clear circumferential resection margins (CRM)** are crucial for local control, the presence of **lymph node metastases** (Stage III disease) and **extramural vascular invasion (EMVI)** signifies a substantial risk of systemic recurrence. - Omitting adjuvant chemotherapy in Stage III rectal cancer would lead to a significantly higher risk of distant metastasis and reduced overall survival. *Long-course chemoradiotherapy followed by chemotherapy* - Postoperative **chemoradiotherapy** is typically indicated for **low and mid-rectal cancers** with involved margins or those at high risk of local recurrence who did not receive appropriate neoadjuvant therapy. - For an **upper rectal cancer** with clear resection margins after a complete **TME**, the risk of pelvic local recurrence is generally low, making additional postoperative pelvic radiotherapy unnecessary. *Short-course radiotherapy followed by chemotherapy* - **Short-course radiotherapy** is a **neoadjuvant (pre-operative)** treatment strategy for rectal cancer, not an adjuvant (post-operative) one in this context. - It aims to improve local control prior to surgery in selected high-risk or borderline resectable cases, and is not given after a complete surgical resection. *Adjuvant radiotherapy alone for 5 weeks* - Radiotherapy alone is insufficient for **Stage III rectal cancer** as it only addresses local disease and offers no benefit against potential **micrometastatic systemic disease**. - For an **upper rectal tumor** with clear margins post-TME, the primary concern is systemic recurrence, which requires chemotherapy, not further local treatment with radiotherapy alone.
Question 40: A 60-year-old man undergoes emergency repair of a strangulated right inguinal hernia. Intraoperatively, a segment of small bowel within the hernia sac appears dusky but after reduction and observation for 10 minutes, it shows improved colour with visible peristalsis. However, there remains a 2cm area of questionable viability without obvious perforation. What is the most appropriate intraoperative decision?
- A. Complete the hernia repair and plan for second-look laparoscopy in 24 hours
- B. Resect the questionable bowel segment with primary anastomosis and complete hernia repair (Correct Answer)
- C. Return the bowel to the abdomen, complete hernia repair, and observe clinically
- D. Apply warm saline packs for further 15 minutes and reassess viability
- E. Perform bowel resection with formation of an end ileostomy
Explanation: ***Resect the questionable bowel segment with primary anastomosis and complete hernia repair*** - In the setting of a **strangulated hernia**, any segment of bowel that remains of **questionable viability** after initial observation must be resected to prevent postoperative **perforation and peritonitis**. - If viability criteria like **color, peristalsis, and arterial pulsation** remain doubtful after 10-15 minutes, **resection** with **primary anastomosis** is the safest definitive management in a stable patient. *Complete the hernia repair and plan for second-look laparoscopy in 24 hours* - **Second-look procedures** are typically reserved for extensive **mesenteric ischemia** cases where maximizing bowel length is critical, not localized questionable viability in a hernia. - This approach increases the risk of **sepsis** and requires a second major surgical intervention that could often be avoided by definitive primary management. *Return the bowel to the abdomen, complete hernia repair, and observe clinically* - This approach is highly risky as **clinical observation** cannot reliably detect early bowel necrosis until life-threatening **peritonitis** or perforation occurs. - Surgeons often **overestimate viability**, and returning necrotic tissue significantly increases the morbidity and mortality associated with the hernia repair. *Apply warm saline packs for further 15 minutes and reassess viability* - The standard period for assessing reperfusion and viability after reduction is generally **10 to 15 minutes**; further delay is unlikely to significantly change the clinical status of the tissue. - Prolonging the intraoperative time without definitive action increases **anesthetic risk** and delays addressing the definitively ischemic segment. *Perform bowel resection with formation of an end ileostomy* - **End ileostomy** is generally reserved for patients with gross **peritoneal contamination**, hemodynamic instability, or very distal segments where primary anastomosis is technically challenging or unsafe. - For a localized 2cm area of questionable viability without other complicating factors, **primary anastomosis** is typically preferred as it avoids the morbidity of a stoma and a second reversal surgery.
Practice by Chapter
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free