Gastrointestinal surgery: low anterior resection syndrome: 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 · Gastrointestinal surgery: low anterior resection syndrome

Sample item

Six months after an ultra-low anterior resection with a coloanal anastomosis, a man has urgency, clustering of stools within an hour and frequent passage of small amounts. There is no anastomotic leak or recurrence. What best explains his symptoms?

ABacterial overgrowth in a blind loopBLoss of the rectal reservoir with disturbed anorectal controlCShort bowel syndrome from extensive resectionDBile acid malabsorption from terminal ileal loss

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

The answer and the reasoning

B. Loss of the rectal reservoir with disturbed anorectal control

Low anterior resection syndrome follows removal of the rectum and mesorectum. The neorectum has poor compliance and reduced reservoir capacity, and neural and sphincter function are disturbed, causing urgency, fragmentation, clustering and sometimes incontinence. Management includes diet, antidiarrhoeals, pelvic floor training and transanal irrigation.

Option by option

A. Bacterial overgrowth in a blind loop
No blind loop is created by a straight coloanal anastomosis.
B. Loss of the rectal reservoir with disturbed anorectal control (correct)
Correct. The loss of the reservoir plus disturbed sphincter and neural control produces the syndrome.
C. Short bowel syndrome from extensive resection
Only the rectum and part of the colon have been removed, so absorptive surface is not the issue.
D. Bile acid malabsorption from terminal ileal loss
The terminal ileum is intact in this operation.

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 B, Loss of the rectal reservoir with disturbed anorectal control. Low anterior resection syndrome follows removal of the rectum and mesorectum.

Why is "Bacterial overgrowth in a blind loop" not the answer?

No blind loop is created by a straight coloanal anastomosis.

Why is "Short bowel syndrome from extensive resection" not the answer?

Only the rectum and part of the colon have been removed, so absorptive surface is not the issue.

Why is "Bile acid malabsorption from terminal ileal loss" not the answer?

The terminal ileum is intact in this operation.

What concept does this question test?

It tests Gastrointestinal surgery: low anterior resection syndrome in General Surgery. The neorectum has poor compliance and reduced reservoir capacity, and neural and sphincter function are disturbed, causing urgency, fragmentation, clustering and sometimes incontinence. Management includes diet, antidiarrhoeals, pelvic floor training and transanal irrigation.

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 Gastrointestinal surgery: low anterior resection syndrome?

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.