Gastrointestinal surgery: perforated duodenal ulcer: 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: perforated duodenal ulcer

Sample item

A 45-year-old NSAID user has sudden severe epigastric pain with a board-like abdomen. Erect chest film shows gas under the right hemidiaphragm. He is resuscitated and consents to surgery. What is the usual operation for a small anterior duodenal perforation?

AGraham omental patch repair with peritoneal lavageBTruncal vagotomy with drainage in every caseCBillroth II gastrectomyDObservation with antibiotics alone in an unstable patient

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

The answer and the reasoning

A. Graham omental patch repair with peritoneal lavage

A perforated duodenal ulcer is treated by simple closure reinforced with an omental (Graham) patch, laparoscopic or open, plus H pylori testing and eradication. Acid-reducing resections are rarely needed in the PPI era. Non-operative treatment is only for selected sealed perforations in stable patients.

Option by option

A. Graham omental patch repair with peritoneal lavage (correct)
Correct. Omental patch repair is the standard.
B. Truncal vagotomy with drainage in every case
Definitive acid surgery is not routine now that H pylori and PPIs are treatable.
C. Billroth II gastrectomy
Gastrectomy is excessive in an acute contaminated field.
D. Observation with antibiotics alone in an unstable patient
Peritonitis with instability needs urgent operation.

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, Graham omental patch repair with peritoneal lavage. A perforated duodenal ulcer is treated by simple closure reinforced with an omental (Graham) patch, laparoscopic or open, plus H pylori testing and eradication.

Why is "Truncal vagotomy with drainage in every case" not the answer?

Definitive acid surgery is not routine now that H pylori and PPIs are treatable.

Why is "Billroth II gastrectomy" not the answer?

Gastrectomy is excessive in an acute contaminated field.

Why is "Observation with antibiotics alone in an unstable patient" not the answer?

Peritonitis with instability needs urgent operation.

What concept does this question test?

It tests Gastrointestinal surgery: perforated duodenal ulcer in General Surgery. Acid-reducing resections are rarely needed in the PPI era. Non-operative treatment is only for selected sealed perforations 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: perforated duodenal ulcer?

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.