Colorectal: complicated diverticulitis: 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: complicated diverticulitis

Sample item

A 55-year-old man has 4 days of left iliac fossa pain and fever. He is haemodynamically stable with localised tenderness and no peritonism. CT shows sigmoid diverticulitis with a 6 cm pericolic abscess and no free gas. What is the most appropriate management?

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

The answer and the reasoning

B. Intravenous antibiotics with CT-guided percutaneous drainage

Diverticulitis with an abscess larger than about 4 cm (Hinchey Ib or II) in a stable patient is treated with intravenous antibiotics and percutaneous image-guided drainage. This often avoids emergency surgery and allows elective resection later if needed. Diffuse purulent or faecal peritonitis (Hinchey III or IV) needs laparotomy.

Option by option

  • A. Oral antibiotics and early discharge

    Oral antibiotics suit uncomplicated diverticulitis and cannot clear a large abscess.

  • B. Intravenous antibiotics with CT-guided percutaneous drainage (correct)

    Drainage plus antibiotics controls sepsis in a stable patient and avoids emergency surgery with a stoma.

  • C. Urgent colonoscopy to exclude carcinoma

    Colonoscopy during acute diverticulitis risks perforation and is deferred for about 6 weeks.

  • D. Emergency Hartmann procedure

    Emergency resection is for generalised peritonitis or failed drainage, not a localised drainable abscess in a stable patient.

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.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Intravenous antibiotics with CT-guided percutaneous drainage. Diverticulitis with an abscess larger than about 4 cm (Hinchey Ib or II) in a stable patient is treated with intravenous antibiotics and percutaneous image-guided drainage.

Why is "Oral antibiotics and early discharge" not the answer?

Oral antibiotics suit uncomplicated diverticulitis and cannot clear a large abscess.

Why is "Urgent colonoscopy to exclude carcinoma" not the answer?

Colonoscopy during acute diverticulitis risks perforation and is deferred for about 6 weeks.

Why is "Emergency Hartmann procedure" not the answer?

Emergency resection is for generalised peritonitis or failed drainage, not a localised drainable abscess in a stable patient.

What concept does this question test?

It tests Colorectal: complicated diverticulitis in General Surgery. This often avoids emergency surgery and allows elective resection later if needed. Diffuse purulent or faecal peritonitis (Hinchey III or IV) needs laparotomy.

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 Colorectal: complicated diverticulitis?

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.