# Small bowel resection with primary anastomosis with resection of the mese



## bill2doc (Jul 25, 2012)

Can someone please help me with the CPT code(s) for the below. Confusing myself 
I am coding for main doc not dr.x even though Dr. X asking for codes too...???

PREOPERATIVE DIAGNOSIS:**Right ovarian dermoid cyst with torsion.

POSTOPERATIVE DIAGNOSIS:**Torsed mesenteric tumor of the small bowel.

PROCEDURE:**Small bowel resection with primary anastomosis with resection of the mesenteric tumor.

DESCRIPTION OF PROCEDURE:** Patient was in the supine position and had been prepped and draped in the standard fashion.**A Pfannenstiel incision had been used to obtain entrance into the abdominal cavity, and the pelvic organs were exposed.**Examination by Dr. X had noted no evidence of involvement of the ovaries or uterus, but rather a mass that was approximately 10 x 12 cm in diameter that generated from the mesentery and was not invading any of the pelvic organs.**It had been partially torsed, which was the likely cause of her pain.**This torsion had been relieved by Dr. X. *Upon my arrival, I examined the bowel and noted no other evidence of other masses.**The colon appeared to be normal, and the appendix was also normal.**Due to the incision, the transverse colon and the hepatic and splenic flexures on the colon were unable to be directly visualized; however, intraabdominal palpation noted no evidence of palpable lesions.**This mass was approximately 40-60 cm from the terminal ileum and appeared to arise from the mesentery itself.**It was nonpulsatile, was soft and fatty similar to a lipoma.**It ran directly underneath the bowel at this level and given the fact that removal of this segment of mesentery would also likely devascularize, this segment of bowel incision was just made to just perform a small bowel resection bloc with the tumor.**The mesentery on either side of the mass was divided, and the small bowel was divided using a linear cutting stapler.**The mesentery was then scored around the mass circumferentially and then divided and ligated progressively using clamps and a 3-0 silk suture for the vessels.**A larger vessel appeared to be at the base of this mass and was feeding it.**It was oversewn with a 3-0 silk suture ligature.**All the bleeding was well controlled.**The mass and the small bowel were then able to be passed off the field as specimen.**The bowel was then again run and evaluated for potential torsion of the mesentery.**None was identified.**The bowel was then reapproximated in a standard side-to-side fashion using an Endo-GIA stapler.**The resulting enterotomy was closed using TA stapler.**The mesentery defect was then closed using a running 3-0 Vicryl.**Further examination of the small bowel noted an area of the small bowel mesentery approximately 15 cm from the site of resection.**It appeared to have been eroded through, likely from pressure of the mass, as there was no real evidence that there is any sort of local invasion from tissue reaction.**It was just a hole appeared to be in the mesentery at this point.**This hole was examined and then closed using 3-0 Vicryl to avoid any threat of internal hernias.**The abdomen was then copiously irrigated with warm sterile normal saline.**There was no evidence of ongoing hemorrhage or leakage noted at this time.**The abdomen and pelvis were then closed in the standard fashion using 2-0 Vicryl and then 0 Prolene for the fascial layers.**The skin was closed with staples.**Dressings were then applied.**The patient was allowed to awaken from anesthesia and brought to Recovery Room in good condition.


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