Gastrointestinal surgery: stercoral perforation: 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: stercoral perforation

Sample item

A bedridden 80-year-old with chronic constipation has generalised peritonitis. CT shows a dilated sigmoid colon packed with faeces and free air. What is the likely mechanism?

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

The answer and the reasoning

C. Pressure necrosis of the bowel wall by a faecal mass

Stercoral perforation follows pressure necrosis of the colonic wall by hard impacted faeces, usually in the sigmoid, and carries high mortality. It needs resection with Hartmann procedure.

Option by option

  • A. Toxic dilatation in colitis

    Toxic dilatation occurs with acute colitis.

  • B. Perforated diverticulum

    Diverticular disease shows inflamed diverticula without an impacted faecal mass.

  • C. Pressure necrosis of the bowel wall by a faecal mass (correct)

    Correct. A faecal mass causes pressure necrosis and perforation.

  • D. Mesenteric artery thrombosis

    Mesenteric thrombosis shows pneumatosis and lactic acidosis.

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.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Pressure necrosis of the bowel wall by a faecal mass. Stercoral perforation follows pressure necrosis of the colonic wall by hard impacted faeces, usually in the sigmoid, and carries high mortality.

Why is "Toxic dilatation in colitis" not the answer?

Toxic dilatation occurs with acute colitis.

Why is "Perforated diverticulum" not the answer?

Diverticular disease shows inflamed diverticula without an impacted faecal mass.

Why is "Mesenteric artery thrombosis" not the answer?

Mesenteric thrombosis shows pneumatosis and lactic acidosis.

What concept does this question test?

It tests Gastrointestinal surgery: stercoral perforation in General Surgery. It needs resection with Hartmann procedure.

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: stercoral perforation?

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.