Colorectal: ulcerative colitis surgery: 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 · Colorectal: ulcerative colitis surgery

Sample item

A 28-year-old woman with extensive ulcerative colitis has relapsed repeatedly despite maximal medical therapy and is steroid-dependent. Biopsies show no dysplasia and the anal sphincter is normal. She wants to avoid a permanent stoma. Which operation is most suitable?

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

The answer and the reasoning

C. Restorative proctocolectomy with ileal pouch-anal anastomosis

Ulcerative colitis is a continuous mucosal disease that always involves the rectum, so a cure requires removal of the entire colon and rectum. Restorative proctocolectomy with an ileal J-pouch anastomosed to the anus restores continence and avoids a permanent stoma. It is typically staged with a temporary defunctioning ileostomy.

Option by option

  • A. Subtotal colectomy with ileorectal anastomosis

    Leaving the rectum retains diseased mucosa with ongoing symptoms and cancer risk, so it is rarely chosen in ulcerative colitis.

  • B. Hartmann procedure with end colostomy

    A Hartmann procedure leaves a permanent stoma and a diseased rectal stump.

  • C. Restorative proctocolectomy with ileal pouch-anal anastomosis (correct)

    This removes all diseased mucosa, cures the disease and preserves anal continence.

  • D. Right hemicolectomy with ileocolic anastomosis

    A segmental resection leaves diseased colon and rectum, and the disease would persist.

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, Restorative proctocolectomy with ileal pouch-anal anastomosis. Ulcerative colitis is a continuous mucosal disease that always involves the rectum, so a cure requires removal of the entire colon and rectum.

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

Leaving the rectum retains diseased mucosa with ongoing symptoms and cancer risk, so it is rarely chosen in ulcerative colitis.

Why is "Hartmann procedure with end colostomy" not the answer?

A Hartmann procedure leaves a permanent stoma and a diseased rectal stump.

Why is "Right hemicolectomy with ileocolic anastomosis" not the answer?

A segmental resection leaves diseased colon and rectum, and the disease would persist.

What concept does this question test?

It tests Colorectal: ulcerative colitis surgery in General Surgery. Restorative proctocolectomy with an ileal J-pouch anastomosed to the anus restores continence and avoids a permanent stoma. It is typically staged with a temporary defunctioning ileostomy.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Colorectal: ulcerative colitis surgery?

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.