# Deep Excision of Abdominal Wall Abscess



## sirisha (Jan 31, 2013)

Hi

If anyone can help in deriving the correct codes for this chart. Thanks in advance..........
Excison is done on deep layers of abdomen wall upto omentum.

Procedures performed:
1. Excison of abdominal wall abscess.
2. Exploratory laparotomy
3. Compled lysis of adhesions
4. Complex closure 18 CM

Procedure in Detail:

After general anesthesia was induced, the patient was intubated without any complications. Once the ET tube was fixed in place, I then began to prep and drape the abdomen in the usual sterile fashion. The patienht also has mild laxity of the abdominal wall. At this time, decision was to excise the abdominal was abscess along the scar revison. The markings was made on the abdomen. Incision was then made with the #15 blade full-thickness down to the skin and subcutaneous tissue. The sinus abscess tract was then probed to identify the direction. At this time, incision again was then carefully carried down. At this time, it appears that the sinus tract was all the way into the fascia. At the time care was taken as the dissection was carried very carefully as the patient has multiple abdominal surgeries and massive adhesions.

The lateral abdominal wall and fascia was carefully elevated and i then began with careful lysis of adhesions with menzenbaum scissors. Same technique was used on the contralateral side. The whole entire abscess including the fascia was then released and this was then excised. Again, care was taken with the adhesions to release the bowel from the underside of this abdominal wall fascia. At this time, it appears there was what apperas to be devitalized black streak of bowel right where the abscess was, there was a browish green discharge and it appreas to be connected with the abscess tract, At this time it was afraid that the patient may have a fistula.  At this time i continued the exploratory laparotomy and the complex lysis of adhesions. Findings showed the patient has a ventral hernia with bowels through the weakened ventral wall, which appreas like there are multiple weaknesses.  The adhesion was carried until there was a good 5 to 6 cm of margin of the fascia had no intraabdominal contents adhere to it. At this time, the transverse colon was identified along with the small bowel. The omentum was then elevated and it appreas that there was no enterocutaneous fistula. It appears this is an intraabdominbal omental abscess with tract to the cutaneous level. At this time the omentum was then excised and ligated.  Abdominal wall abscess was then excised at this time and sent for pathology.  The wound was then irrigated out and washed cut and the bowel was then carefully run and explored. At this time it was decided that we will close the abdomen using a looped pds of the fascia followed by a 2-0 vicryl suture in the deep subcutaneous tissued followed by 3-0 vicryl for the dermis followed by skin staples. The irregular shaped scar was excised and closed in layers. A totol of 18 cm of complex closure was performed, the patient understands that this is a tension closure and abdominal binder was then placed after it was sterilly dressed. The patient was weaned off general anesthesia and extubated.  The patient was brought back to recovery room in stable condition. The patient will be admitted for observation and pain control and IV antibiotics.

Thanks.
Sirisha


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