**Question:** In Fothergill's operation following is done -

A. Dissection of the descending colon
B. Division of the splenic flexure
C. Resection of the affected segment
D. Division of the sigmoid colon

**Core Concept:** Fothergill's operation is a surgical procedure primarily described for the management of gangrenous appendicitis and perforated peptic ulcer. The key to understanding this question is to know the surgical steps involved in the management of these conditions.

**Why the Correct Answer is Right:**

Fothergill's operation involves the following steps:

1. **Dissection of the descending colon**: Dissection of the descending colon is crucial to ensure adequate mobilization and exposure of the affected segment. This step prevents injury to the adjacent structures and facilitates proper exposure for resection.

2. **Division of the splenic flexure**: In gangrenous appendicitis, the splenic flexure is divided to prevent spread of infection and to avoid contamination of the peritoneal cavity. In perforated peptic ulcer, division of the splenic flexure helps to prevent contamination and allows for proper exposure of the affected segment for resection.

3. **Resection of the affected segment**: This step involves removing the gangrenous or perforated segment of the involved bowel to halt the spread of infection and prevent complications.

4. **Division of the sigmoid colon**: The sigmoid colon is divided in some versions of Fothergill's operation, especially in gangrenous appendicitis cases. This helps prevent the spread of infection to the pelvic cavity and ensures proper exposure for the subsequent steps.

**Why Each Wrong Option is Incorrect:**

**Option A (Resection of the sigmoid colon):** Although important in some cases of gangrenous appendicitis, this step is not always necessary. In other cases, the sigmoid colon can be approached through the splenic flexure, avoiding the need for its division.

**Option B (Resection of the ascending colon):** In the context of gangrenous appendicitis, resecting the ascending colon is not a typical step in Fothergill's operation. The primary focus is on the affected segment, which is typically the appendix in appendicitis cases.

**Option C (Division of the sigmoid colon):** As explained above, this step is not a universal part of Fothergill's operation and can be approached through the splenic flexure without sigmoid colon division in some cases.

**Option D (Division of the rectum and sigmoid colon):** This is an unnecessary step in Fothergill's operation for gangrenous appendicitis or perforated peptic ulcer disease. The primary focus is on the affected segment, which is typically the appendix in appendicitis cases.

**Core Concept:**

Fothergill's operation is a surgical procedure performed to manage gangrenous appendicitis and perforated peptic ulcer disease. The primary aim is to resect the gangrenous or perforated segment and prevent further contamination of the peritoneal cavity