SELF/Repair of Perforations/Repair of Perforations 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 64-year-old man presents with acute abdominal pain, rigidity, free air under the diaphragm, and lactate of 4.2. He is hemodynamically unstable but responsive to fluids. You prepare for laparotomy. Which combination best reflects the appropriate initial operative priorities?

	Rapid midline access and immediate perforation repair before lavage
	Controlled entry, suction of contaminants, quadrant-based warm saline irrigation
	Short transverse incision and minimal irrigation to reduce operative time
	Early bowel resection before addressing contamination

A young woman with suspected perforated duodenal ulcer requires emergent surgery. She has severe asthma and limited ventilatory tolerance. How should anesthesia considerations integrate with operative planning?

	Attempt spinal anesthesia only if abdominal relaxation appears achievable
	Proceed with general anesthesia because spinal anesthesia is contraindicated in emergencies
	Avoid spinal anesthesia because it increases leakage risk after Graham patch
	Use local anesthesia for midline laparotomy to avoid respiratory compromise

During laparotomy for suspected ileal perforation, you find one small perforation but also significant feculent contamination. What integrated decision-making principle should guide your next step?

	Complete quadrant-based lavage before formal bowel inspection
	Proceed directly to closure now that the perforation is identified
	Begin repair immediately to minimize operative time in contamination
	Leave contamination in place if a single perforation is confirmed

A stable patient’s gastric perforation is repaired with a Graham patch. During the leak test, fine bubbles appear along one suture. Which step aligns with the module’s recommendations?

	Reinforce the area with additional seromuscular sutures
	Proceed to closure because small bubbles are expected
	Convert to segmental gastric resection immediately
	Place a second omental patch without modifying sutures

A man with typhoid ileitis has multiple friable perforations. He is tachycardic but responsive to fluids. Which integrated surgical strategy is most appropriate?

	Primary closure of each perforation in a single layer
	Mandatory exteriorization regardless of contamination
	Segmental resection with primary anastomosis if physiology permits
	Graham patch for all perforations

A patient consents to possible Graham patch repair. Intraoperatively, you discover large areas of necrotic small bowel. What is the appropriate communication-related principle guiding your decision?

	Proceed with the operation, documenting that intraoperative judgment required a change
	Limit the operation to the consented procedure only
	Delay resection until additional consent can be obtained
	Convert to nonoperative management due to lack of updated consent

During exploration you identify the perforation early but have not yet run the bowel. Your trainee suggests proceeding to closure. What principle should guide your response?

	Closure should precede further inspection to minimize operative time
	Running the bowel is optional if contamination is controlled
	Early closure is safe once the perforation is localized
	Full bowel inspection must still be completed to avoid missed perforations

A patient with delayed presentation and heavy contamination undergoes repair. What is the most appropriate drain strategy?

	One closed suction drain placed near—but not touching—the repair
	No drains should ever be used in contaminated fields
	Two passive drains placed directly on the suture line
	Only a large-bore passive drain is acceptable

A postoperative patient on day 2 develops tachycardia and abdominal distension. Drain output increases and appears bilious. What integrated management step is most appropriate?

	Remove the drain to prevent further contamination
	Continue routine care unless fever develops
	Evaluate urgently for intra-abdominal sepsis
	Advance diet to assess bowel function

In a low-resource facility, your suction device fails during lavage. What substitution is most consistent with the module’s adaptation guidance?

	Use large-bore syringes with catheters for aspiration
	Proceed without suction because lavage alone is sufficient
	Replace lavage with dry gauze wiping
	Skip irrigation and focus solely on rapid closure

Page data
Keywords	surgery, health
SDG	SDG03 Good health and well-being
Authors	Global Surgical Training Challenge
License	CC-BY-SA-4.0
Organizations	WACS, SELF
Language	English (en)
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Redirects	WACS Training Modules/Repair of Perforations/Repair of Perforations Module Test
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Created	November 13, 2025 by KatKor
Last edit	March 9, 2026 by Ian-laurel
Cite as	KatKor (2025–2026). "SELF/Repair of Perforations/Repair of Perforations Module Test". Appropedia. Retrieved June 4, 2026.
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