Gastrointestinal surgery: retroperitoneal fibrosis: 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.

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General Surgery · Gastrointestinal surgery: retroperitoneal fibrosis

Sample item

A 55-year-old man has dull back pain, a raised ESR and rising creatinine. CT shows a plaque of soft tissue around the aorta, and imaging shows both ureters pulled medially with proximal hydronephrosis. What is the best initial management?

ARelieve the obstruction with stents or nephrostomy and start corticosteroidsBRadical nephrectomyCBilateral ureteric reimplantationDImmediate open ureterolysis with omental wrapping

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

The answer and the reasoning

A. Relieve the obstruction with stents or nephrostomy and start corticosteroids

In idiopathic retroperitoneal fibrosis the obstruction is relieved with ureteric stents or nephrostomies while corticosteroids reduce the inflammatory mass. Ureterolysis with omental wrapping is kept for steroid failure or relapse. Biopsy excludes malignancy and lymphoma.

Option by option

A. Relieve the obstruction with stents or nephrostomy and start corticosteroids (correct)
Correct. Decompress the kidneys and treat the inflammatory plaque with steroids.
B. Radical nephrectomy
Nephrectomy is not indicated for a benign bilateral obstructive process.
C. Bilateral ureteric reimplantation
Reimplantation does not address the periureteric encasement.
D. Immediate open ureterolysis with omental wrapping
Ureterolysis is second line after medical treatment fails.

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, Relieve the obstruction with stents or nephrostomy and start corticosteroids. In idiopathic retroperitoneal fibrosis the obstruction is relieved with ureteric stents or nephrostomies while corticosteroids reduce the inflammatory mass.

Why is "Radical nephrectomy" not the answer?

Nephrectomy is not indicated for a benign bilateral obstructive process.

Why is "Bilateral ureteric reimplantation" not the answer?

Reimplantation does not address the periureteric encasement.

Why is "Immediate open ureterolysis with omental wrapping" not the answer?

Ureterolysis is second line after medical treatment fails.

What concept does this question test?

It tests Gastrointestinal surgery: retroperitoneal fibrosis in General Surgery. Ureterolysis with omental wrapping is kept for steroid failure or relapse. Biopsy excludes malignancy and lymphoma.

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 Gastrointestinal surgery: retroperitoneal fibrosis?

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.