# Subtotal Colectomy with ileostomy - Help



## RainyDaze (Dec 26, 2011)

Here is the op report.  Thanks for your help!


Dx: Bowel Perforation

Operations Performed: 1) Exploratory Laparotomy, 2) Subtotal Colectomy

Operative Findings:  THere was a perforation of the transverse colon at the splenic flexure with facal peritonits.  There was a ferforation of the sigmoid colon creating a coloenteric fustual which was more chronic and walled off.  The remainder of the small bowel, stomach and colon was notable for generalized pallor and lock of motility. There was a small amount of free fluid in the peritoneal cavity.


Operative Performed:  The midline incision was reopened and the peritoneal cavity was entered.  Adhesions to the anterior abdominal wall were taken down.  The most notable abnormality was the coloenteric fistula in the pelvis.  This was between the antimesenteric border of the sigmoid colon and the mid jejunum.  It was also stuck to the left horn of the uterus and the peritoneal surface overlying the sacrum.  The fistual was dismantled.  The colon was transected proximal andthe distal to the fistula with a contour stapler.  The smal bowel was transected proximal and distal to the fistula.

The bowel was reanastomosed using the GIA stapler.  A side to side functional end to end anastomosis was fashioned.  The enterotomy was closed with a TA stapler.  There was no significant mesenteric defect.  

The segment of colon which was responsible for the fistula was dissected off the abdomial wall taking care to stay directly on the surface of the colon rather injure the ureter.  There was no obvious evidence of malignancy.

The peritoneal cavity was then irrigated.  The peritoneum along the lft apracolic gutter was incised in order to bring out a colostomy.  This revealed obvious purulent fluid coming from the region of the splenic flexure.  This area was explored and the lesser sac was entered above the tranverse mescolon.  This revealed the other perforation.  There was a small amount of feculent material in the area which increased in the process of mobilizing the transverse colon.  A decision was made to perform a subtotal colectomy back to the previous ileocolostomy as the patient probably has some type os ischemic colotis and her risk of perforation is too great.  The mesentery of the descending colone and transverse colon was clamped, divided, and ligated near the bowel wall.  The ileum was transcated near the ileocolostomy and the specimen was removed.  The peritoneal cavity was copiously irrigated with warm normal saline.  The spleen was checked for injuires.  None was found.  Sponge, needle and instrument counts were correct.  The ileum was broght out through the right side of the abdominal wall was an ileostomy.  The midline fascia was closed with heavy nylon.  The would was packed open.  The ileostomy was matured.  An appliance was secured.


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## RainyDaze (Dec 28, 2011)

Any thoughts?  I'm thinking 44140, 44310-51?


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## surgonc87 (Jan 4, 2012)

44143, 44650, 44310...no CCI edits


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