Colon: toxic megacolon: 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 · Colon: toxic megacolon

Sample item

A patient with severe ulcerative colitis has fever, tachycardia, and a transverse colon diameter of 7 cm on abdominal film. After 48 hours of intravenous steroids, fluids and antibiotics he worsens. What is the appropriate surgery?

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

The answer and the reasoning

D. Subtotal colectomy with end ileostomy

Toxic megacolon is a transverse colon above 6 cm with systemic toxicity. Initial care is bowel rest, fluids, steroids and antibiotics, and failure to improve within 24 to 72 hours or perforation requires surgery. Subtotal colectomy with end ileostomy is safest, leaving the rectal stump for later reconstruction.

Option by option

  • A. Colonoscopic decompression

    Endoscopy risks perforating a fragile colon.

  • B. Loop colostomy alone

    Diversion alone does not remove the diseased bowel.

  • C. Right hemicolectomy

    Right hemicolectomy leaves diseased colon.

  • D. Subtotal colectomy with end ileostomy (correct)

    Correct. This is the standard emergency operation for refractory toxic colitis.

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 D, Subtotal colectomy with end ileostomy. Toxic megacolon is a transverse colon above 6 cm with systemic toxicity.

Why is "Colonoscopic decompression" not the answer?

Endoscopy risks perforating a fragile colon.

Why is "Loop colostomy alone" not the answer?

Diversion alone does not remove the diseased bowel.

Why is "Right hemicolectomy" not the answer?

Right hemicolectomy leaves diseased colon.

What concept does this question test?

It tests Colon: toxic megacolon in General Surgery. Initial care is bowel rest, fluids, steroids and antibiotics, and failure to improve within 24 to 72 hours or perforation requires surgery. Subtotal colectomy with end ileostomy is safest, leaving the rectal stump for later reconstruction.

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 Colon: toxic megacolon?

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.