Gastrointestinal surgery: pouchitis: 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: pouchitis

Sample item

Eight months after restorative proctocolectomy with an ileal pouch for ulcerative colitis, a man has increased stool frequency, urgency, abdominal cramps and low-grade fever. Pouchoscopy shows an inflamed pouch mucosa with no stricture. What is the first-line treatment?

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

The answer and the reasoning

A. Oral metronidazole or ciprofloxacin

Pouchitis is nonspecific inflammation of the ileal pouch and responds to a short course of metronidazole or ciprofloxacin. Pouch excision is reserved for chronic refractory disease.

Option by option

  • A. Oral metronidazole or ciprofloxacin (correct)

    Correct. Antibiotic therapy with metronidazole or ciprofloxacin is first-line for pouchitis.

  • B. Mesalazine enemas as sole therapy

    Mesalazine enemas treat distal colitis and are not first-line for pouchitis.

  • C. Oral vancomycin

    Oral vancomycin treats Clostridioides difficile, which has not been shown here.

  • D. Revision to an end ileostomy

    Stoma formation is reserved for refractory disease after medical therapy fails.

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.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Oral metronidazole or ciprofloxacin. Pouchitis is nonspecific inflammation of the ileal pouch and responds to a short course of metronidazole or ciprofloxacin.

Why is "Mesalazine enemas as sole therapy" not the answer?

Mesalazine enemas treat distal colitis and are not first-line for pouchitis.

Why is "Oral vancomycin" not the answer?

Oral vancomycin treats Clostridioides difficile, which has not been shown here.

Why is "Revision to an end ileostomy" not the answer?

Stoma formation is reserved for refractory disease after medical therapy fails.

What concept does this question test?

It tests Gastrointestinal surgery: pouchitis in General Surgery. Pouch excision is reserved for chronic refractory disease.

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 Gastrointestinal surgery: pouchitis?

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.