Colorectal Surgery Practice Questions

Q: A young male patient presents with complete rectal prolapse and no history of previous surgeries. The surgery of choice is:

Abdominal rectopexy. ***Abdominal rectopexy*** - **Abdominal rectopexy** is considered the surgery of choice for **complete rectal prolapse** in young, fit patients due to its superior long-term results in terms of recurrence rates. - This procedure involves addressing the prolapse via an abdominal approach, often by fixing the rectum to the sacrum, and may include sigmoid resection if there is a redundant colon. *Delorme's procedure* - This is a **perineal approach** that involves plication of the prolapsed rectal mucosa and muscle. - It is generally favored in **elderly** or **frail patients** due to its lower morbidity, but it has a higher recurrence rate compared to abdominal approaches. *Anterior resection* - **Anterior resection** is primarily a procedure for removing a diseased segment of the **left colon or rectum**, typically for cancer or diverticular disease. - While it may be combined with rectopexy if a redundant sigmoid colon is present, it is not the primary or sole treatment for rectal prolapse itself. *Goodsall's procedure* - **Goodsall's rule** is a principle used to predict the internal opening of an anal fistula based on the external opening's location, and **Goodsall's procedure** is not a named surgical technique for rectal prolapse. - This option appears to be a distractor, as there is no specific surgical procedure for rectal prolapse named after Goodsall.

Q: Most common site of chronic fissure in the anus is

Posterior. ***Posterior*** - The **posterior midline** is the most common site for anal fissures due to it being less well-supported and poorly vascularized, making it susceptible to trauma during defecation. - The internal anal sphincter pulls the anoderm in the posterior midline, making it the most common site of injury and fissure formation in both sexes. *Anterior* - While anterior fissures can occur, they are much less common than posterior fissures, accounting for a smaller percentage of all chronic fissures. - Anterior fissures are more common in women due to the different angles of the anterior anal canal in relation to the vaginal introitus, but still less frequent than posterior ones. *Anterolateral* - Fissures rarely occur in an anterolateral position. Anal fissures typically appear in the midline anteriorly or posteriorly. - This location is not anatomically predisposed to the same degree of trauma or stress experienced by the anterior or posterior midline during defecation. *Lateral* - **Lateral fissures** are uncommon and should raise suspicion for other underlying conditions, such as **inflammatory bowel disease** (Crohn's disease), tuberculosis, or malignancy [1]. - The anal canal's support and vascularization are generally better in the lateral aspects, making primary fissure formation here less likely.

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.

Question 1

A 28-year-old previously healthy woman arrives in the emergency room complaining of 24 hours of anorexia and nausea, and lower abdominal pain that is more intense in the right lower quadrant than elsewhere. On examination, she has peritoneal signs in the right lower quadrant and a rectal temperature of 38.38°C (101.8°F). At exploration through an incision in the right lower quadrant, she is found to have a small, contained perforation of a cecal diverticulum. Which of the following statements regarding cecal diverticula is true?

Accepted Answer

Diverticulectomy, closure of the cecal defect, and appendectomy may be indicated.

Answer

Cecal diverticula are often solitary but rarely require surgical intervention.

Answer

Cecal diverticula are typically acquired pseudodiverticula like sigmoid diverticula.

Answer

Cecal diverticula are pseudodiverticula that commonly present with perforation.

Question 2

A patient with a non-obstructing carcinoma of the sigmoid colon is being prepared for elective resection. To minimize the risk of postoperative infectious complications, what should be included in your planning?

Accepted Answer

A single preoperative parenteral dose of antibiotic effective against aerobes and anaerobes may provide initial coverage.

Answer

Postoperative administration for 5 to 7 days of parenteral antibiotics effective against aerobes and anaerobes

Answer

Postoperative administration for 2 to 4 days of parenteral antibiotics effective against aerobes and anaerobes

Answer

Avoidance of oral antibiotics to prevent emergence of Clostridioides difficile

Question 3

A young male patient presents with complete rectal prolapse and no history of previous surgeries. The surgery of choice is:

Accepted Answer

Abdominal rectopexy

Answer

Delorme's procedure

Answer

Anterior resection

Answer

Goodsall's procedure

Question 4

Most common site of chronic fissure in the anus is

Accepted Answer

Posterior

Answer

Answer

Anterolateral

Answer

Lateral

Question 5

All of the following are true regarding pilonidal sinus except:

Accepted Answer

Seen predominantly in women

Answer

Most commonly occurs in sacrococcygeal region

Answer

Obesity is a risk factor

Answer

tendency for recurrence

Question 6

Procedure of choice in ulcerative colitis with acute perforation is

Accepted Answer

Total colectomy and ileostomy

Answer

Defunctioning ileostomy

Answer

Closure of perforation

Answer

Proximal diversion colostomy

Colorectal Surgery — MCQs

Colorectal Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?