# Exploratory laparotomy,Lysis of adhesions,Mesenteric repair - A midline incision was



## bill2doc (Jun 21, 2013)

Little help with CPT codes please.  Getting 44005 and 44850-59  ???


A midline incision was then made and carried through the subcutaneous tissue to the fascia.  The fascia was incised and the abdomen opened.  Of note, the colon was dilated and protruding through the incision.  The abdomen was then explored in a systematic fashion.  The small bowel was eviscerated and traced proximally.  The ligament of trietz was identified.  The small bowel was then run.  The proximal jejunal loops were dilated and appeared irritated, but no evidence of injury.  The small bowel was stuck in the left lower quadrant, but manipulation of the overlying colon allowed the bowel to be freed.  At this point a transition point was identified.  The small bowel had been compressed but was not ischemic.  The point of obstruction was at the distal jejuneum/ proximal ileum.  The bowel was further examined.  In the mid ileum, there was adhesional disease to the anterior abdominal wall which was divided.  The scarred bowel at this location showed no evidence of obstruction, but the fixation point was concerning for potential development of internal herniation.  The serosa was injured during this maneuver and the tears were repaired with lembert sutures of 3-0 silk.  At this point the entire small bowel was free.  There were no other areas of concern and no points of further obstruction.  Examination of the entire colon was notable for significant amount of redundant descending colon.  The mesentery of this segment of colon appeared stretched.  The growth of this colon had distorted the distal bands usually forming the white line of toldt.  There were extra bands of tissue extending to the mesentery of the colon.  These bands formed a pocket and the mesentery of the colon appeared mildly inflamed at this location.  It seems that the small bowel had herniated into this pocket, causing the obstruction.  The mouth of this mesenteric defect was then closed with 3-0 silk.  There were no other lesions noted after complete exploration of the abdomen.  Nasogastric tube position was verified and secured.  The bowel was then reduced into the abdomen.  The abdominal incision was then closed. The skin was closed.  Dressings applied.


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