# Multiple colon resections colostomy's (HELP)



## Williealawishes (Dec 31, 2009)

Hello.  I would love any advice on this one.  I am looking at 
44144
44141-59
44139
But what about code 44160.......
Am I even warm on this one?????
Thanks-Tracy


                             OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS:  Acute sigmoid diverticulitis.

PROCEDURES PERFORMED
1. Exploratory laparotomy.
2. Sigmoid colon resection.
3. Right hemicolectomy.
4. Mobilization of splenic flexure.
5. Ileostomy.
6. Colostomy.
7. Mucus fistula.

POSTOPERATIVE DIAGNOSES
1. Acute sigmoid diverticulitis with abscess.
2. Perforated cecum.

Patient is a 37-year-old gentleman who recently was admitted to the
hospital for an episode of diverticulitis.  Discharged on oral antibiotics
which he did not complete the course.  He was then readmitted for the same.
He appeared to have a stricture in his sigmoid colon.  He developed a small
bowel obstruction and was then taken to the operating room after
conservative measures failed for treatment of his diverticulitis.

After informed consent was obtained, the patient was taken to the operating
room and placed supine on the table.  General anesthesia was administered.
The patient's abdomen was then prepped and draped in sterile fashion.  The
patient was then placed in lithotomy position.  A generous midline incision
was made and carried down through the skin and subcutaneous tissues until
the fascia was reached.  The fascia was incised in the midline.  The
abdominal cavity was then explored.  There were numerous adhesions of the
small bowel to the pelvis at this area of inflammation, causing the
subsequent small bowel obstruction.  The small bowel was very edematous.  I
evaluated the cecum.  It was markedly dilated and did have an area of
necrosis.  We then evaluated the sigmoid colon.  There was a very dense
inflamed mass with omentum adherent.  I then identified a distal resection
margin and then fired the contour stapler across this and mobilized the
colon from its lateral attachments, both with blunt and sharp dissection.
I then divided it proximally.  The mesentery was then divided with the
ligature device.  As there was not going to be enough mobilization for a
tension-free ostomy, I then mobilized the splenic flexure without any
difficulty using electrocautery and the ligature device.  There was a large
amount of stool present within the colon.  The colon was markedly dilated.
I then re-evaluated this patient's right colon where again the right colon
was mobilized along the line of Toldt up around the hepatic flexure.  I
then identified the distal resection margin with what appeared to be viable
colon.  I then divided this again with the contour stapler.  I also divided
the terminal ileum with contour stapler.  The mesentery was then divided
with __________ ligature device.  It appeared that the best option for the
patient at this time would be to do an ileostomy and mucous fistula as well
as colostomy.  I then made 2 elliptical incisions in the patient's lower
quadrants and carried these down through the skin and subcutaneous tissues
until the fascia was reached.  A cruciate incision was made in the fascia,
and I then dilated through with 3 fingers.  The sigmoid colon was brought
through the left defect ileum and proximal colon was brought through the
right.  These were secured with Babcock clamps.  We did try to evacuate
some of the stool in doing this to help facilitate closure as well as
maturation of the stomas.  After adequate hemostasis had been achieved and
adequate irrigation had been performed, I then placed a Jackson-Pratt drain
in the patient's pelvis.  I then closed the fascia with looped 0 Biosyn
suture.  The skin was then closed with surgical staples.  A dressing was
applied.  Both the ileostomy and the colostomy were matured in the standard
fashion with 3-0 Vicryl suture.  The mucous fistula was performed just
adjacent to the ostomy, and a 22-French red rubber catheter was placed
within this to provide for antegrade irrigation.  Ostomy appliances were
applied.  A Jackson-Pratt drain was sewn in place with a 3-0 nylon suture.
The patient tolerated the procedure well.  There were no complications.
The patient was transferred to the recovery room intubated and in guarded
condition.


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## jplouffe (Jan 4, 2010)

*multiple colon resection*

I recently had the same challenge.  I would use 44141, 44160,59 and 44139.
Hope this helps.


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## Williealawishes (Jan 6, 2010)

Thank you so much for your reply!!!!!  I submitted as you suggested, Thanks!


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