Obstetric emergencies: timing of rectovaginal fistula repair: practice question

A OBG 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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OBG · Obstetric emergencies: timing of rectovaginal fistula repair

Sample item

A woman develops faecal leakage per vagina 10 days after a vaginal delivery complicated by a fourth-degree tear. Examination shows an inflamed, oedematous rectovaginal fistula. What is the best plan?

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

The answer and the reasoning

D. Defer repair for about 3 months to allow inflammation to settle, with a diversion if she is symptomatic

Early repair of an inflamed fistula often fails because tissues are oedematous and infected. Waiting about 3 months allows healing and resolution of oedema before a definitive layered repair. Temporary measures such as hygiene and, if needed, a diversion help meanwhile.

Option by option

  • A. No intervention, as it will certainly close spontaneously

    Established fistulae rarely close without surgery.

  • B. Permanent colostomy at once

    A permanent stoma is excessive for a repairable fistula.

  • C. Immediate repair at the bedside under local anaesthetic

    A hurried repair in inflamed tissue has a high failure rate.

  • D. Defer repair for about 3 months to allow inflammation to settle, with a diversion if she is symptomatic (correct)

    Correct. Waiting allows tissues to become supple before definitive repair.

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 OBG question

What is the answer to this OBG question?

The best answer is D, Defer repair for about 3 months to allow inflammation to settle, with a diversion if she is symptomatic. Early repair of an inflamed fistula often fails because tissues are oedematous and infected.

Why is "No intervention, as it will certainly close spontaneously" not the answer?

Established fistulae rarely close without surgery.

Why is "Permanent colostomy at once" not the answer?

A permanent stoma is excessive for a repairable fistula.

Why is "Immediate repair at the bedside under local anaesthetic" not the answer?

A hurried repair in inflamed tissue has a high failure rate.

What concept does this question test?

It tests Obstetric emergencies: timing of rectovaginal fistula repair in OBG. Waiting about 3 months allows healing and resolution of oedema before a definitive layered repair. Temporary measures such as hygiene and, if needed, a diversion help meanwhile.

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 Obstetric emergencies: timing of rectovaginal fistula repair?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG 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.