Perioperative: anastomotic 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 · Perioperative: anastomotic leak

Sample item

On the sixth day after an anterior resection, a man has fever of 38.8 degrees Celsius, tachycardia of 118 per minute, lower abdominal pain, and a raised CRP and white cell count. He has localised tenderness without peritonism and is haemodynamically stable. What is the most appropriate investigation?

ACT of the abdomen and pelvis with intravenous and rectal contrastBRepeat blood tests in 48 hoursCPlain abdominal radiographDImmediate re-laparotomy without imaging

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

The answer and the reasoning

A. CT of the abdomen and pelvis with intravenous and rectal contrast

Anastomotic leak typically presents between the fifth and seventh postoperative days with fever, tachycardia, ileus and rising inflammatory markers. In a stable patient without peritonitis, contrast CT confirms the leak and any collection and guides percutaneous drainage or surgery. Generalised peritonitis or instability needs laparotomy without delay.

Option by option

A. CT of the abdomen and pelvis with intravenous and rectal contrast (correct)
Contrast-enhanced CT identifies leakage and collections in a stable patient.
B. Repeat blood tests in 48 hours
Waiting 48 hours delays diagnosis and increases the risk of sepsis.
C. Plain abdominal radiograph
Plain films are insensitive and cannot demonstrate a leak or collection.
D. Immediate re-laparotomy without imaging
Re-laparotomy without imaging is for peritonitis or instability, which are absent here.

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, CT of the abdomen and pelvis with intravenous and rectal contrast. Anastomotic leak typically presents between the fifth and seventh postoperative days with fever, tachycardia, ileus and rising inflammatory markers.

Why is "Repeat blood tests in 48 hours" not the answer?

Waiting 48 hours delays diagnosis and increases the risk of sepsis.

Why is "Plain abdominal radiograph" not the answer?

Plain films are insensitive and cannot demonstrate a leak or collection.

Why is "Immediate re-laparotomy without imaging" not the answer?

Re-laparotomy without imaging is for peritonitis or instability, which are absent here.

What concept does this question test?

It tests Perioperative: anastomotic leak in General Surgery. In a stable patient without peritonitis, contrast CT confirms the leak and any collection and guides percutaneous drainage or surgery. Generalised peritonitis or instability needs laparotomy without delay.

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 Perioperative: anastomotic 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.