# Exploratory laparotomy, small bowel decompression and closure of dehiscence



## ksb0211 (Aug 25, 2011)

I don't want to miss anything here.  Would just like some other opinions.  Thanks.

PRE/POST-OPERATIVE DIAGNOSIS
Abdominal wound dehiscence.

NAME OF PROCEDURE
Exploratory laparotomy, small bowel decompression and closure of dehiscence.

DESCRIPTION OF PROCEDURE
The patient was taken to the OR.  After induction of adequate general anesthesia, the patient was prepped with Betadine and draped sterilely.  Skin staples were removed and the abdominal wall immediately fell apart exposing omentum.  The omentum and adhesions to the anterior abdominal wall were gradually taken down.  Ultimately it was noted that there was markedly distended small bowel.  The patient was the completely eviscerated.  The distention continued up towards the ligament of Treitz was most marked distally.  There was air into the cecum but it appeared that the transverse colon was relatively devoid of the gas.  The decision was to decompress the small bowel as its volume was basically twice that of the peritoneal cavity at this point.  The pursestring of 2-0 silk was placed distally in the small bowel and the pool sucker was placed and we evacuated approximately 2.5L of fluid from the gut.  The suction device was passed through the ileocecal valve and then the proximal bowel was well decompressed.  Ultimately, the enterotomy was closed with a TA60 stapling device.  Once this was done I was better able to explore the abdominal cavity.  No overt significant adhesions were encountered.  Air was noted down into the sigmoid colon.  No masses are appreciated.  No volvulus or point of obstruction could be identified.  The abdominal cavity was then well irrigated with antibiotic saline.  The wound edges were then debrided sharply.  The wound was then reapproximated with running double stranded #1 PDS suture.  Retention sutures of #2 nylon were placed.  The wound was packed open.  A gauze dressing was applied.  The patient tolerated the procedure.  Nasogastric tube had been placed intraoperatively.  The patient was taken recovery room in guarded condition.


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## slpagel (Aug 25, 2011)

I would use 49002-78 and check with the surgeon, but I think you could use 44021-59, and 43753.
Good Luck!


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## colorectal surgeon (Aug 25, 2011)

49002-79

44021

13160?

What about "The wound edges were debrided sharply"?

I disagree with 43753 as almost surely the nasogastric tube was placed by anesthesia


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