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Bowel perforation after colonoscopy — USMLE Step 2 CK MCQ

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ModerateSurgeryBowel perforation after colonoscopyUSMLE Step 2 CK

A 56-year-old Middle Eastern woman comes to the urgent care clinic because of abdominal pain or gastrointestinal symptoms. History and focused examination are notable for severe abdominal pain, fever, peritonitis, and free intraperitoneal air. Temperature is 102.2°F (39.0°C), blood pressure is 108/66 mmHg, pulse is 112/min, respirations are 22/min, and oxygen saturation is 94% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and imaging support an acute surgical process without suggesting a safer outpatient approach. Which of the following is the most likely diagnosis?

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Correct answer: D — Bowel perforation after colonoscopy

The vignette describes Bowel perforation after colonoscopy, supported by severe abdominal pain, fever, peritonitis, and free intraperitoneal air. Bowel perforation after colonoscopy is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: American Society for Gastrointestinal Endoscopy Adverse Events Guideline