WBR0266

Author	PageAuthor::Vendhan Ramanujam
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Gastrointestinal, SubCategory::Surgery
Prompt	[[Prompt::A 36 year old man who sustained a gunshot wound to the left buttock is brought to the ER. No exit wound is found during examination. He is hemodynamically stable with a blood pressure of 110/70 mm Hg. His heart rate is 90/min and his respiratory rate is 16/min. An X ray of the abdomen shows the bullet to be located in his right lower quadrant. The most appropriate management of a suspected rectal injury in this patient will include]]
Answer A	AnswerA::Barium studies of the colon and rectum
Answer A Explanation	AnswerAExp::'''Incorrect'''-The use of barium is contraindicated since spillage of barium mixed with feces into the peritoneal cavity would increase the likelihood of subsequent intraabdominal abscess.
Answer B	AnswerB::Barium studies of the bullet track
Answer B Explanation	AnswerBExp::'''Incorrect'''-The use of barium is contraindicated since spillage of barium mixed with feces into the peritoneal cavity would increase the likelihood of subsequent intraabdominal abscess.
Answer C	AnswerC::Endoscopy of the bullet track
Answer C Explanation	AnswerCExp::'''Incorrect'''-Instrumentation of the bullet track is also contraindicated because of the risk of injury to adjacent structures (e.g., bladder, ureters, iliac vessels).
Answer D	AnswerD::Angiography
Answer D Explanation	AnswerDExp::'''Incorrect'''-Angiography is not a sensitive method for demonstrating injury to the intestinal wall.
Answer E	AnswerE::Sigmoidoscopy in the emergency room
Answer E Explanation	[[AnswerEExp::Correct-Penetrating injury to the intraperitoneal or extraperitoneal rectum should be diagnosed by immediate sigmoidoscopy. When sigmoidoscopy is inconclusive, contrast studies of the rectum using a watersoluble radiopaque medium such as gastrografin can be done.]]
Right Answer	RightAnswer::E
Explanation	[[Explanation::Penetrating injury to the intraperitoneal or extraperitoneal rectum should be diagnosed by immediate sigmoidoscopy. When sigmoidoscopy is inconclusive, contrast studies of the rectum using a watersoluble radiopaque medium such as gastrograffin can be done. Educational Objective: Penetrating injury to the intraperitoneal or extraperitoneal rectum should be diagnosed by immediate sigmoidoscopy. Only when sigmoidoscopy is inconclusive, contrast studies of the rectum using a watersoluble radiopaque medium such as gastrograffin can be done. Barium studies and instrumentation to track the bullet are contraindicated. Educational Objective: References: ]]
Approved	Approved::Yes
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