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Postoperative urinary retention — USMLE Step 3 MCQ

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HardSurgery (Post-operative / Follow-up)Postoperative urinary retentionUSMLE Step 3

On postoperative day 7 after an open colectomy, a 64-year-old man coughs and feels a tearing sensation. The incision opens and loops of small bowel protrude through the wound. He is anxious, blood pressure is 104/66 mm Hg, and the exposed bowel appears pink. Which immediate management is most appropriate?

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Correct answer: A — Cover exposed bowel with saline-moistened dressings and proceed to operative closure

The best answer is “Cover exposed bowel with saline-moistened dressings and proceed to operative closure”. Evisceration proves complete fascial dehiscence and is a surgical emergency. Exposed viscera should be protected from desiccation and trauma with sterile saline-moistened dressings while the patient is kept NPO, receives resuscitation and antibiotics as indicated, and returns urgently to the operating room. Bedside closure or direct negative pressure can injure bowel and delays definitive fascial repair.

Reference: NCBI Bookshelf: Fascial Dehiscence: https://www.ncbi.nlm.nih.gov/books/NBK551644/