Gastrointestinal surgery: Hartmann procedure: 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: Hartmann procedure

Sample item

A 72-year-old with ischaemic heart disease has faecal peritonitis from perforated sigmoid diverticulitis and is in septic shock. Which operation is generally safest?

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

The answer and the reasoning

D. Sigmoid resection with end colostomy and closed rectal stump

In unstable patients with gross faecal contamination, Hartmann procedure avoids an anastomosis in a septic, poorly perfused field. Restoration of continuity is attempted months later. Primary anastomosis with diverting ileostomy is an option in stable patients.

Option by option

  • A. Laparoscopic lavage alone

    Lavage is unsuitable for faecal peritonitis.

  • B. Total colectomy with ileorectal anastomosis

    Total colectomy is excessive for a localised sigmoid source.

  • C. Primary anastomosis without diversion

    An undiverted anastomosis risks leak in sepsis.

  • D. Sigmoid resection with end colostomy and closed rectal stump (correct)

    Correct. Hartmann is the safe choice in sepsis with faecal peritonitis.

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 D, Sigmoid resection with end colostomy and closed rectal stump. In unstable patients with gross faecal contamination, Hartmann procedure avoids an anastomosis in a septic, poorly perfused field.

Why is "Laparoscopic lavage alone" not the answer?

Lavage is unsuitable for faecal peritonitis.

Why is "Total colectomy with ileorectal anastomosis" not the answer?

Total colectomy is excessive for a localised sigmoid source.

Why is "Primary anastomosis without diversion" not the answer?

An undiverted anastomosis risks leak in sepsis.

What concept does this question test?

It tests Gastrointestinal surgery: Hartmann procedure in General Surgery. Restoration of continuity is attempted months later. Primary anastomosis with diverting ileostomy is an option in stable patients.

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: Hartmann procedure?

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.