Gastrointestinal surgery: neutropenic enterocolitis: 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: neutropenic enterocolitis

Sample item

A 34-year-old with acute leukaemia on induction chemotherapy has an absolute neutrophil count of 200 per microlitre, fever and right lower quadrant pain. CT shows a thickened, oedematous caecal wall with pericaecal stranding and no free air or abscess. What is the best initial management?

AEmergency right hemicolectomyBLaparoscopic appendicectomyCColonoscopic decompressionDBowel rest with broad-spectrum antibiotics

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

The answer and the reasoning

D. Bowel rest with broad-spectrum antibiotics

Neutropenic enterocolitis (typhlitis) usually settles with bowel rest, fluids, broad-spectrum antibiotics covering Gram-negative organisms and anaerobes, and supportive care including growth factors. Surgery is reserved for perforation, uncontrolled bleeding or clinical deterioration despite medical treatment, because operating on a neutropenic patient carries very high risk.

Option by option

A. Emergency right hemicolectomy
Resection is reserved for perforation, abscess or failure of medical therapy, and carries high mortality in neutropenia.
B. Laparoscopic appendicectomy
The appendix is not the primary pathology; the caecal wall is diffusely inflamed.
C. Colonoscopic decompression
Endoscopy and insufflation risk perforating a friable, ischaemic caecal wall and offer no benefit here.
D. Bowel rest with broad-spectrum antibiotics (correct)
Correct. Without perforation or peritonitis, conservative management is the standard first step.

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 D, Bowel rest with broad-spectrum antibiotics. Neutropenic enterocolitis (typhlitis) usually settles with bowel rest, fluids, broad-spectrum antibiotics covering Gram-negative organisms and anaerobes, and supportive care including growth factors.

Why is "Emergency right hemicolectomy" not the answer?

Resection is reserved for perforation, abscess or failure of medical therapy, and carries high mortality in neutropenia.

Why is "Laparoscopic appendicectomy" not the answer?

The appendix is not the primary pathology; the caecal wall is diffusely inflamed.

Why is "Colonoscopic decompression" not the answer?

Endoscopy and insufflation risk perforating a friable, ischaemic caecal wall and offer no benefit here.

What concept does this question test?

It tests Gastrointestinal surgery: neutropenic enterocolitis in General Surgery. Surgery is reserved for perforation, uncontrolled bleeding or clinical deterioration despite medical treatment, because operating on a neutropenic patient carries very high risk.

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 Gastrointestinal surgery: neutropenic enterocolitis?

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.