Hernia and abdominal wall: open abdomen after damage control: 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 · Hernia and abdominal wall: open abdomen after damage control

Sample item

After a damage control laparotomy for severe haemorrhage, the bowel is grossly swollen and the fascia cannot be approximated without high tension. What is the best approach?

AClose the skin tightly over the swollen bowelBForce fascial closure with heavy tension suturesCLeave the abdomen open with temporary negative-pressure closureDBridge the defect with permanent mesh at once

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

The answer and the reasoning

C. Leave the abdomen open with temporary negative-pressure closure

Closing under tension in a swollen abdomen raises intra-abdominal pressure and risks abdominal compartment syndrome. The open abdomen is temporarily covered, often with a negative-pressure dressing, and delayed fascial closure is attempted once oedema has settled.

Option by option

A. Close the skin tightly over the swollen bowel
Tight skin closure over swollen bowel raises intra-abdominal pressure in the same way as fascial closure.
B. Force fascial closure with heavy tension sutures
Closing the fascia under tension risks compartment syndrome and fascial necrosis.
C. Leave the abdomen open with temporary negative-pressure closure (correct)
Correct. A temporary open abdomen avoids compartment syndrome while oedema resolves.
D. Bridge the defect with permanent mesh at once
Permanent mesh in a contaminated, swollen field risks infection and fistula and is not used acutely.

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, Leave the abdomen open with temporary negative-pressure closure. Closing under tension in a swollen abdomen raises intra-abdominal pressure and risks abdominal compartment syndrome.

Why is "Close the skin tightly over the swollen bowel" not the answer?

Tight skin closure over swollen bowel raises intra-abdominal pressure in the same way as fascial closure.

Why is "Force fascial closure with heavy tension sutures" not the answer?

Closing the fascia under tension risks compartment syndrome and fascial necrosis.

Why is "Bridge the defect with permanent mesh at once" not the answer?

Permanent mesh in a contaminated, swollen field risks infection and fistula and is not used acutely.

What concept does this question test?

It tests Hernia and abdominal wall: open abdomen after damage control in General Surgery. The open abdomen is temporarily covered, often with a negative-pressure dressing, and delayed fascial closure is attempted once oedema has settled.

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 Hernia and abdominal wall: open abdomen after damage control?

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.