# Altemeier procedure, perineal proctosigmoidectomy



## bda23054 (Sep 6, 2012)

Please help coding this procedure...

NAME OF OPERATION
Altemeier procedure, perineal proctosigmoidectomy.

ANESTHESIA
General endotracheal anesthesia.

INDICATIONS 
This 74-year-old female has been dealing with what she thought was hemorrhoids for several years off and on.  She says she has pain and rectal bleeding.  On physical exam, it appeared that she had a large internal hemorrhoid, so patient was brought in for a hemorrhoidectomy.

DESCRIPTION OF OPERATION
The patient was brought to the operating room table and placed in the lithotomy position.  General endotracheal anesthesia was induced and the perineum was prepped and draped in the usual sterile fashion.  Once anesthetic was induced, the patient was noted on the have a large rectal prolapse.  Once the area was prepped, perineum was exposed revealing a large fleshy mass protruding about 8 cm from the anus.  Bovie was used to score the outside of the colon.  The bowel wall was divided in circular fashion using Bovie.  Once the outer layer of the bowel had been divided, two techniques were used to free the rectum from its pelvic abdominal attachments anteriorly.  The Bovie was used predominantly to divide the fat and mesentery posteriorly.  Hemostasis was achieved using Kelly clamps to isolate the segment of mesentery before Bovie was used.  After the bowel had been freed proximal to the dentate line the bowel was separated leaving anal mucosa in a rectal segment.  At this point, rectal sutures 2-0 Vicryl were placed in the rectum at 12, 3 and 9 o'clock and once this had stabilized the new anastomosis, in a segmental fashion sutures were used to attach the rectum to the anal mucosa.  Once this was completed, the rectal stump the pulled the anal mucosa into the pelvis.  The wound was dressed with 4 x 4's and 0.5% Marcaine with epinephrine were injected into the area.


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## jflorezc (Jun 28, 2016)

45130


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