# Revision of jejunostomy tube



## myang6879 (Nov 17, 2011)

Hi,

I need help on finding a cpt code for revision of a jejunostomy tube, if anyone could help me that will be greatly  appreciate it.   
Thanks

DESCRIPTION OF PROCEDURE
The patient was brought to the operating room, placed in supine position, and
prepped and draped in the usual sterile manner. An upper incision was made
through which the subcutaneous tissue was divided using electrocautery. The
abdomen was entered sharply. The Witzel jejunostomy tube was easily
identifiable. The sutures holding it to the anterior abdominal wall were
removed. The suture holding the tube to the skin was removed. The small bowel
with the tube was brought out through a midline incision. The Witzel tunnel
was inspected. This may have caused compromise of the lumen of the small
bowel. The Witzel tunnel was removed. The sutures were removed. A pursestring
suture was replaced around the tube. This maneuver, removing the sutures,
seemed  to relieve the obstruction. It appeared that the lumen was widely
patent. 


The area was irrigated. The bowel was returned to the abdomen and the small
bowel was sutured to the anterior abdominal wall circumferentially around the
J-tube. 


An upper GI endoscopy was then performed. Through the oropharynx after the
patient was chemically relaxed, the Olympus scope was passed. It was passed
into the esophagus under direct endoscopic vision. We were able to identify
in the distal esophagus the cancer and entered the stomach. We then
insufflated and insufflated the duodenum. At the bedside, the air could be
seen passing the area of the J-tube without any evidence of restriction of
flow. There appeared to be no narrowing of the lumen of the small bowel.
Succus was also able to be refluxed through this area seemingly without
resistance. 


The stomach was decompressed. The scope was removed and the esophagus was
inspected in a retrograde fashion. There was no evidence of injury to the
injury to the esophagus. 


The abdomen was copiously irrigated. Two cc were placed into the jejunal tube
balloon. The balloon was anchored to the skin with a 4-0 Vicryl stitch. The
wound was irrigated again and injected with 0.25% Marcaine. The fascia was
closed with 0 looped Maxon followed by a 3-0 Vicryl, and then a 4-0 Vicryl
subcuticular stitch. Steri-Strips were placed. The wounds were dressed. The
patient was brought to recovery in good condition. There were no
complications and the patient tolerated the procedure well.


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## johnmeyer (Nov 20, 2011)

I found 44373 for revision of a jejunostomy tube.


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