Gastric cancer: Blumer shelf: 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 · Gastric cancer: Blumer shelf

Sample item

A 60-year-old man with weight loss and early satiety is found to have gastric adenocarcinoma. On digital rectal examination there is a hard, nodular, extramucosal shelf on the anterior rectal wall. What is the mechanism of this finding?

AHaematogenous spread through the portal vein to the rectal wallBDirect invasion from the posterior rectal wallCTranscoelomic seeding of malignant cells into the rectovesical pouchDLymphatic spread to the internal iliac nodes

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

The answer and the reasoning

C. Transcoelomic seeding of malignant cells into the rectovesical pouch

Blumer shelf is a palpable mass in the rectovesical pouch (rectouterine pouch in women) felt on rectal examination. It reflects peritoneal seeding of intraperitoneal malignancy, classically gastric cancer, which settles in the most dependent part of the peritoneal cavity. It indicates peritoneal metastasis and unresectability. The ovarian counterpart is the Krukenberg tumour.

Option by option

A. Haematogenous spread through the portal vein to the rectal wall
Portal venous spread produces liver deposits, not a rectal shelf in the peritoneal pouch.
B. Direct invasion from the posterior rectal wall
A shelf on the anterior wall lies outside the mucosa and arises from the peritoneal pouch, not from the rectum.
C. Transcoelomic seeding of malignant cells into the rectovesical pouch (correct)
Malignant cells shed into the peritoneal cavity gravitate to the pelvic pouch, forming the shelf.
D. Lymphatic spread to the internal iliac nodes
Nodal spread would give enlarged nodes and not a continuous palpable shelf.

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 C, Transcoelomic seeding of malignant cells into the rectovesical pouch. Blumer shelf is a palpable mass in the rectovesical pouch (rectouterine pouch in women) felt on rectal examination.

Why is "Haematogenous spread through the portal vein to the rectal wall" not the answer?

Portal venous spread produces liver deposits, not a rectal shelf in the peritoneal pouch.

Why is "Direct invasion from the posterior rectal wall" not the answer?

A shelf on the anterior wall lies outside the mucosa and arises from the peritoneal pouch, not from the rectum.

Why is "Lymphatic spread to the internal iliac nodes" not the answer?

Nodal spread would give enlarged nodes and not a continuous palpable shelf.

What concept does this question test?

It tests Gastric cancer: Blumer shelf in General Surgery. It reflects peritoneal seeding of intraperitoneal malignancy, classically gastric cancer, which settles in the most dependent part of the peritoneal cavity. It indicates peritoneal metastasis and unresectability. The ovarian counterpart is the Krukenberg tumour.

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 Gastric cancer: Blumer shelf?

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.