In the context of surgical contamination, an inflamed appendix removed during laparotomy is classified as which level of contamination?

• A. Clean
• B. Clean-contaminated
• C. Contaminated
• D. Dirty

Answer: (C)

In this context, the level of contamination hinges on whether the operation involves entering the gastrointestinal tract with ongoing inflammation and the potential for gut bacteria to enter the abdominal cavity. An inflamed appendix that is removed through laparotomy means the GI tract has been opened and an inflammatory process is present, which introduces gut bacteria into the operative field. Even without perforation, that combination of bowel entry and active inflammation increases the microbial load in the peritoneal cavity, so this scenario fits the contaminated category. If there were a perforation with frank pus or foul contamination, it would rise to dirty, and if the GI tract entry occurred without inflammation or contamination, it would be clean-contaminated.