Abdominal wall: rectus sheath haematoma: 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 · Abdominal wall: rectus sheath haematoma

Sample item

A 70-year-old man taking warfarin develops sudden pain and a tender, firm swelling in the right lower abdomen after a bout of coughing. The mass does not cross the midline and stays palpable when he tenses his abdominal muscles. What is the best investigation?

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

The answer and the reasoning

C. CT of the abdomen

Rectus sheath haematoma follows rupture of the inferior epigastric vessels, and a mass that remains palpable on tensing the rectus (Fothergill sign) indicates an abdominal wall origin. CT confirms it and shows its size and active bleeding. Most are managed conservatively with correction of coagulopathy.

Option by option

  • A. Colonoscopy

    Colonoscopy examines the lumen of the colon and does not image the abdominal wall.

  • B. Diagnostic laparoscopy

    Laparoscopy is an invasive step not required to diagnose an abdominal wall haematoma.

  • C. CT of the abdomen (correct)

    Correct. CT shows the haematoma and distinguishes it from an intra-abdominal mass.

  • D. Barium enema

    Barium enema evaluates the colonic lumen and is not helpful 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.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, CT of the abdomen. Rectus sheath haematoma follows rupture of the inferior epigastric vessels, and a mass that remains palpable on tensing the rectus (Fothergill sign) indicates an abdominal wall origin.

Why is "Colonoscopy" not the answer?

Colonoscopy examines the lumen of the colon and does not image the abdominal wall.

Why is "Diagnostic laparoscopy" not the answer?

Laparoscopy is an invasive step not required to diagnose an abdominal wall haematoma.

Why is "Barium enema" not the answer?

Barium enema evaluates the colonic lumen and is not helpful here.

What concept does this question test?

It tests Abdominal wall: rectus sheath haematoma in General Surgery. CT confirms it and shows its size and active bleeding. Most are managed conservatively with correction of coagulopathy.

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 Abdominal wall: rectus sheath haematoma?

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.