Perioperative care: postoperative ileus: 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 · Perioperative care: postoperative ileus

Sample item

On day 3 after a colectomy, a patient has abdominal distension, no flatus and absent bowel sounds. Radiographs show gas in dilated small and large bowel, with a serum potassium of 2.8 mmol/L and no signs of peritonitis. What is the best next step?

ARelaparotomyBNeostigmine infusionCCorrect the electrolytes and continue supportive careDGastrografin enema

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

The answer and the reasoning

C. Correct the electrolytes and continue supportive care

Generalised gas-filled bowel with no peritonitis points to adynamic ileus, which is aggravated by hypokalaemia and opioids. Treatment is correcting potassium and other electrolytes, adequate fluids and minimising opioids. Relaparotomy is considered if a mechanical cause or leak is suspected.

Option by option

A. Relaparotomy
Relaparotomy is not indicated in the absence of peritonitis or evidence of leak.
B. Neostigmine infusion
Neostigmine is reserved for colonic pseudo-obstruction after exclusion of mechanical causes and correction of electrolytes.
C. Correct the electrolytes and continue supportive care (correct)
Correct. Hypokalaemia worsens ileus, and correcting it with supportive care is the first step.
D. Gastrografin enema
A contrast enema looks for a mechanical lesion and does not treat hypokalaemia-related ileus.

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, Correct the electrolytes and continue supportive care. Generalised gas-filled bowel with no peritonitis points to adynamic ileus, which is aggravated by hypokalaemia and opioids.

Why is "Relaparotomy" not the answer?

Relaparotomy is not indicated in the absence of peritonitis or evidence of leak.

Why is "Neostigmine infusion" not the answer?

Neostigmine is reserved for colonic pseudo-obstruction after exclusion of mechanical causes and correction of electrolytes.

Why is "Gastrografin enema" not the answer?

A contrast enema looks for a mechanical lesion and does not treat hypokalaemia-related ileus.

What concept does this question test?

It tests Perioperative care: postoperative ileus in General Surgery. Treatment is correcting potassium and other electrolytes, adequate fluids and minimising opioids. Relaparotomy is considered if a mechanical cause or leak is suspected.

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 Perioperative care: postoperative ileus?

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.