Paediatric surgery: anorectal malformation: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Surgery · Paediatric surgery: anorectal malformation

Sample item

A newborn boy has no visible anal opening, a flat perineum and meconium passing in the urine. What is the most appropriate initial management?

ADefunctioning colostomy, with later posterior sagittal anorectoplastyBImmediate perineal anoplastyCPrimary pull-through without a stomaDAnal dilatation

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Defunctioning colostomy, with later posterior sagittal anorectoplasty

Meconium in the urine and a flat bottom indicate a high or intermediate lesion with a rectourethral fistula. These need a diverting colostomy in the newborn, followed by distal imaging and definitive posterior sagittal anorectoplasty (PSARP) at a few months. Perineal anoplasty is only for low lesions with a visible perineal fistula.

Option by option

A. Defunctioning colostomy, with later posterior sagittal anorectoplasty (correct)
Correct. A high lesion needs initial diversion and staged reconstruction.
B. Immediate perineal anoplasty
Primary perineal repair is for low defects, which show a perineal opening.
C. Primary pull-through without a stoma
Pull-through without a stoma risks leak and sepsis in a high lesion.
D. Anal dilatation
Dilatation treats anal stenosis, not an absent anus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Defunctioning colostomy, with later posterior sagittal anorectoplasty. Meconium in the urine and a flat bottom indicate a high or intermediate lesion with a rectourethral fistula.

Why is "Immediate perineal anoplasty" not the answer?

Primary perineal repair is for low defects, which show a perineal opening.

Why is "Primary pull-through without a stoma" not the answer?

Pull-through without a stoma risks leak and sepsis in a high lesion.

Why is "Anal dilatation" not the answer?

Dilatation treats anal stenosis, not an absent anus.

What concept does this question test?

It tests Paediatric surgery: anorectal malformation in General Surgery. These need a diverting colostomy in the newborn, followed by distal imaging and definitive posterior sagittal anorectoplasty (PSARP) at a few months. Perineal anoplasty is only for low lesions with a visible perineal fistula.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric surgery: anorectal malformation?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.