Hepatobiliary and pancreatic surgery: post-cholecystectomy bile leak: 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 · Hepatobiliary and pancreatic surgery: post-cholecystectomy bile leak

Sample item

On day 3 after cholecystectomy, a patient has abdominal pain, fever and a collection on ultrasound. A drain yields bile and HIDA scan shows tracer in the collection with an intact CBD on MRCP, suggesting cystic stump leak. What is the best treatment?

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

The answer and the reasoning

C. Percutaneous drainage plus ERCP with biliary stent or sphincterotomy

Drainage controls the collection and ERCP stenting reduces the sphincter pressure gradient so bile flows into the duodenum and the leak seals. Major duct transection requires reconstruction by Roux-en-Y hepaticojejunostomy.

Option by option

  • A. Hepaticojejunostomy in all cases

    Reconstruction is for transection, not a stump leak.

  • B. Immediate Whipple

    Whipple is not a leak treatment.

  • C. Percutaneous drainage plus ERCP with biliary stent or sphincterotomy (correct)

    Correct. Drain the collection and divert bile via ERCP.

  • D. Observation without drainage

    A bilious collection with sepsis needs drainage.

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, Percutaneous drainage plus ERCP with biliary stent or sphincterotomy. Drainage controls the collection and ERCP stenting reduces the sphincter pressure gradient so bile flows into the duodenum and the leak seals.

Why is "Hepaticojejunostomy in all cases" not the answer?

Reconstruction is for transection, not a stump leak.

Why is "Immediate Whipple" not the answer?

Whipple is not a leak treatment.

Why is "Observation without drainage" not the answer?

A bilious collection with sepsis needs drainage.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: post-cholecystectomy bile leak in General Surgery. Major duct transection requires reconstruction by Roux-en-Y hepaticojejunostomy.

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 Hepatobiliary and pancreatic surgery: post-cholecystectomy bile leak?

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.