Colorectal: ischaemic colitis: 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 · Colorectal: ischaemic colitis

Sample item

An elderly woman after aortic surgery has left-sided abdominal pain and bloody diarrhoea. Colonoscopy shows a well-demarcated segment of oedematous, bluish mucosa at the splenic flexure. Why is this area vulnerable?

AIt lacks any submucosal vesselsBIt has the richest collateral supplyCIt is supplied by the internal iliac arteryDIt is a watershed zone between the SMA and IMA territories

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

The answer and the reasoning

D. It is a watershed zone between the SMA and IMA territories

The splenic flexure (Griffiths point) and rectosigmoid junction (Sudeck point) are watershed areas with poor collateral flow, so they are susceptible to low-flow ischaemia. Most cases are managed by fluids and antibiotics, while peritonitis or gangrene needs resection.

Option by option

A. It lacks any submucosal vessels
Submucosal vessels are present.
B. It has the richest collateral supply
The splenic flexure has relatively poor collaterals.
C. It is supplied by the internal iliac artery
The internal iliac supplies pelvic structures.
D. It is a watershed zone between the SMA and IMA territories (correct)
Correct. Watershed areas are the most susceptible to hypoperfusion.

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, It is a watershed zone between the SMA and IMA territories. The splenic flexure (Griffiths point) and rectosigmoid junction (Sudeck point) are watershed areas with poor collateral flow, so they are susceptible to low-flow ischaemia.

Why is "It lacks any submucosal vessels" not the answer?

Submucosal vessels are present.

Why is "It has the richest collateral supply" not the answer?

The splenic flexure has relatively poor collaterals.

Why is "It is supplied by the internal iliac artery" not the answer?

The internal iliac supplies pelvic structures.

What concept does this question test?

It tests Colorectal: ischaemic colitis in General Surgery. Most cases are managed by fluids and antibiotics, while peritonitis or gangrene needs resection.

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 Colorectal: ischaemic colitis?

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.