Question

A 6-year-old boy presented with life-threatening shock. CT showed large ascites, bowel wall thickening and poor or absent enhancement of a strangulated bowel segment, with gangrenous bowel found on surgical exploration. After resection, which statement about the intestinal anastomosis is TRUE?

• A. Should be done by continuous layers as it takes less time
• B. Should be done with catgut
• C. Should be done by single layer seromuscular Lembert sutures
• D. Should be done by single layer taking submucosa

Hint:

The Lembert suture is an inverting seromuscular stitch that does not enter the bowel lumen.

Answer 1

The Correct Option is C

Step 1: Read the clinical clue: ascites, non-enhancing thickened bowel and gangrene equal strangulation needing resection and anastomosis. Focus on the correct suturing principle. Step 2: The gold standard described here is a single layer of inverting seromuscular Lembert sutures. These pass through the serosa and muscularis only, never the lumen, joining two bowel ends with a clean serosa-to-serosa apposition. Step 3: Test the distractors. Speed alone (option a) is a poor reason and risks luminal compromise; plain catgut (option b) is too rapidly absorbed and not the material of choice; an option built on entering the submucosa/lumen (option d) abandons the safe extramucosal principle. Step 4: The single correct surgical statement is the seromuscular Lembert single-layer technique. \[\boxed{\text{Single layer seromuscular Lembert sutures}}\]