SELF/Colostomy/Colostomy Module Test

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Instructions

Work through each question carefully to choose the best answer, and submit the quiz to view your results. After completing the quiz, read through the answer explanations to review the reasoning behind both correct and incorrect options.

A 72-year-old woman with obstructing rectosigmoid carcinoma and localized perforation is found intraoperatively to have a viable proximal colon but friable distal tissue. The patient is hemodynamically stable. What operative plan best balances safety and long-term management?

	Loop colostomy for temporary diversion
	Hartmann’s procedure with immediate reversal planning
	End colostomy with distal closure following resection
	Primary resection and anastomosis without diversion

A patient with severe COPD and bowel obstruction presents in a rural setting without general anesthesia availability. The local anesthetist can safely provide spinal anesthesia. Which principle should guide the surgical approach?

	Proceed under spinal anesthesia if relaxation and monitoring are adequate
	Defer until general anesthesia is available at a referral center
	Attempt local infiltration with minimal sedation
	Perform a percutaneous decompression without stoma creation

During preoperative assessment, a patient with obesity and prior laparotomy scars is scheduled for a colostomy. What consideration most directly affects stoma placement and postoperative function?

	Selection of left lower quadrant by convention
	Choosing the most lateral site for easier appliance fit
	Placing the stoma close to the umbilicus for patient visibility
	Avoiding scars, creases, and bony prominences during site marking

A 60-year-old man with Crohn’s perforation is planned for temporary diversion. During surgery, mesenteric tension prevents the loop from lying flat on the abdominal wall. What is the most appropriate action?

	Incise the mesentery to increase reach
	Mobilize the bowel further to achieve a tension-free position
	Widen the fascial opening to relieve tension
	Proceed with tight fixation to prevent retraction

A patient with advanced rectal cancer agrees to a “temporary” stoma. The surgeon knows the lesion precludes reversal but avoids discussing this to prevent distress. What is the best ethical and clinical approach?

	Proceed without discussing permanence to avoid anxiety
	Delay the discussion until after surgery when prognosis is clearer
	Clarify that the stoma is likely permanent and explain why
	Emphasize only immediate goals of decompression

While creating the stoma-site incision, the resident sharply divides the rectus sheath and begins dissecting laterally rather than separating the rectus muscle fibers. Bleeding obscures the field. What should the supervising surgeon do next?

	Clamp and ligate the area quickly, then proceed with fascial division
	Continue laterally to widen the opening for easier bowel delivery
	Convert to a full midline laparotomy to improve exposure
	Reorient dissection to bluntly separate the rectus fibers along their direction

A trainee creates a small stoma opening through the rectus sheath. After delivering the bowel, it appears congested and dark. What is the most likely technical cause?

	The peritoneum was opened too widely
	The fascial window is too narrow, restricting blood flow
	The stoma sits too close to the umbilicus
	The stoma loop is inadequately supported by a rod

A 55-year-old male with diverticular abscess undergoes stoma formation in a district hospital without electrocautery. Which modification ensures safe dissection and hemostasis?

	Proceed with scalpel and scissors using careful suture ligation
	Delay the case until cautery is available
	Create a wider incision to speed exposure
	Use nonsterile equipment from another theater

During closure after loop colostomy, a resident ties fascial sutures tightly to achieve complete approximation. The supervising surgeon intervenes. What is the concern?

	Loose closure increases infection risk
	Tighter sutures prevent hernia formation
	Overly tight closure may impair perfusion and cause wound dehiscence
	The fascia should always be closed under moderate tension

During stoma creation, the resident notes that the delivered bowel loop lies flush with the skin and does not protrude above the surface. What should the surgeon do at this stage to optimize function?

	Evert and mature the bowel further to ensure adequate protrusion
	Create a second supporting incision above the first
	Apply tighter sutures to keep it in position
	Leave it as is; protrusion will increase with edema

Page data
Keywords	surgery, health
SDG	SDG03 Good health and well-being
Authors	Ian-laurel, SELF Tiger Team
License	CC-BY-SA-4.0
Organizations	WACS, SELF
Language	English (en)
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Created	November 12, 2025 by KatKor
Last edit	March 9, 2026 by Ian-laurel
Cite as	KatKor (2025–2026). "SELF/Colostomy/Colostomy Module Test". Appropedia. Retrieved June 4, 2026.
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