nlbarnes
Expert
44143 (Hartmann's procedure), 49020 (I & D), 44955, & 49322 (need help on 49322)
44143, 49020, 49322, & 44955. 49322 is for lap and I can't find an open code??
PROCEDURES:
1. Diagnostic laparoscopy.
2. exploratory laparotomy
3. Hartmann's procedure.
4. drainage of intra-abdominal abscess.
5. Appendectomy
via laparoscopic approach impossible. The decision was made to convert
the procedure to open.
Bovie cautery was used to make a 30 cm vertical incision.
The incision was carried down through the subcutaneous fat, until the
linea alba was identified.
The fascia was incised and linea alba, and the peritoneal cavity was
entered. severe inflammatory
adhesions were found in the pelvis and the left lower quadrant.
The adhesions were broken by blunt dissection.
Approximately 30mL abscess was encountered medially
to the sigmoid colon. The sample of the purulent exudate was
obtained and sent for cultures.
The sigmoid colon was carefully
mobilized off the lateral abdominal wall and the peritoneum was
Incised on the white line of Toldt allowing for better
mobilization of the sigmoid colon. The dissection continued
cephalad along the lateral side of descending colon, which was
mobilized lateral to medial fashion. After
descending and sigmoid colons were completely mobilized, the
attention then was turned to the pelvis and the distal sigmoid
colon was dissected towards the upper rectum. The left ureter
was identified and no injury to the ureter was noted. The window
in the mesorectum was then performed at the junction of sigmoid
colon and rectum, and with the help of harmonic device. The 60
mm green load of Echelon Endo GIA stapler was then used to staple
off the distal sigmoid colon from the upper rectum. Adequate
staple line was noted with no evidence of bleeding or bowel
content leak. The mesentery of the sigmoid colon was then
transected with an Enseal device going cephalad . The
sigmoid colon was then completely mobilized to the distal
descending colon, which did not appear to be involved in
diverticulitis/diverticulosis.
the entire small bowel was then examined from the ligament of Treitz to
the ileocecal area,
And was found to be grossly normal. The appendix was found to be
secondarily inflamed,
And decision was made to perform an appendectomy.
Another load of Endo GIA 60 blue load stapler was used to staple off the
appendix at its base.
The mesentery was controlled with Enseal device. No bleeding from the
appendiceal vessels was encountered.
The abdominal cavity was then carefully irrigated with
large amount of warm normal saline solution, which was suctioned
out until clear return of the irrigation fluid was obtained. A
19-French Blake drain was placed through the 5 mm port
insertion sites and positioned in the pelvis.
The 10 blade scalpel was then used to make 3 cm in diameter, round
incision in the left lower quadrant. The left rectus muscle fascia
was then excised with Bovie cautery. The muscle
splitting incision was performed in the left rectus muscle
and the peritoneum was incised with Bovie cautery.
The medium Alexis wound protector was then place to decrease the risk
of wound infection. The sigmoid colon was then brought into the wound.
The second load of Endo GIA 60 mm
blue load stapler was then used to staple off the specimen which
was passed off the operating table.
The staple line again
appeared to be hemostatic and patent. The fascia then was closed
With a running #1PDS suture. The colon was then
sutured to the edges of the fascia with several interrupted
3-0 Vicryl sutures. The wound was irrigated with warm normal
saline solution. Meticulous surgical hemostasis was achieved.
The wound appear to hemostatic. The staple line was then excised
with Bovie cautery and the ostomy was formed by suturing the
edges of the bowel to the subcuticular tissue with 3-0 Vicryl.
The ostomy appeared to be patent with no evidence of bleeding.
Ostomy appliance was placed.
44143, 49020, 49322, & 44955. 49322 is for lap and I can't find an open code??
PROCEDURES:
1. Diagnostic laparoscopy.
2. exploratory laparotomy
3. Hartmann's procedure.
4. drainage of intra-abdominal abscess.
5. Appendectomy
via laparoscopic approach impossible. The decision was made to convert
the procedure to open.
Bovie cautery was used to make a 30 cm vertical incision.
The incision was carried down through the subcutaneous fat, until the
linea alba was identified.
The fascia was incised and linea alba, and the peritoneal cavity was
entered. severe inflammatory
adhesions were found in the pelvis and the left lower quadrant.
The adhesions were broken by blunt dissection.
Approximately 30mL abscess was encountered medially
to the sigmoid colon. The sample of the purulent exudate was
obtained and sent for cultures.
The sigmoid colon was carefully
mobilized off the lateral abdominal wall and the peritoneum was
Incised on the white line of Toldt allowing for better
mobilization of the sigmoid colon. The dissection continued
cephalad along the lateral side of descending colon, which was
mobilized lateral to medial fashion. After
descending and sigmoid colons were completely mobilized, the
attention then was turned to the pelvis and the distal sigmoid
colon was dissected towards the upper rectum. The left ureter
was identified and no injury to the ureter was noted. The window
in the mesorectum was then performed at the junction of sigmoid
colon and rectum, and with the help of harmonic device. The 60
mm green load of Echelon Endo GIA stapler was then used to staple
off the distal sigmoid colon from the upper rectum. Adequate
staple line was noted with no evidence of bleeding or bowel
content leak. The mesentery of the sigmoid colon was then
transected with an Enseal device going cephalad . The
sigmoid colon was then completely mobilized to the distal
descending colon, which did not appear to be involved in
diverticulitis/diverticulosis.
the entire small bowel was then examined from the ligament of Treitz to
the ileocecal area,
And was found to be grossly normal. The appendix was found to be
secondarily inflamed,
And decision was made to perform an appendectomy.
Another load of Endo GIA 60 blue load stapler was used to staple off the
appendix at its base.
The mesentery was controlled with Enseal device. No bleeding from the
appendiceal vessels was encountered.
The abdominal cavity was then carefully irrigated with
large amount of warm normal saline solution, which was suctioned
out until clear return of the irrigation fluid was obtained. A
19-French Blake drain was placed through the 5 mm port
insertion sites and positioned in the pelvis.
The 10 blade scalpel was then used to make 3 cm in diameter, round
incision in the left lower quadrant. The left rectus muscle fascia
was then excised with Bovie cautery. The muscle
splitting incision was performed in the left rectus muscle
and the peritoneum was incised with Bovie cautery.
The medium Alexis wound protector was then place to decrease the risk
of wound infection. The sigmoid colon was then brought into the wound.
The second load of Endo GIA 60 mm
blue load stapler was then used to staple off the specimen which
was passed off the operating table.
The staple line again
appeared to be hemostatic and patent. The fascia then was closed
With a running #1PDS suture. The colon was then
sutured to the edges of the fascia with several interrupted
3-0 Vicryl sutures. The wound was irrigated with warm normal
saline solution. Meticulous surgical hemostasis was achieved.
The wound appear to hemostatic. The staple line was then excised
with Bovie cautery and the ostomy was formed by suturing the
edges of the bowel to the subcuticular tissue with 3-0 Vicryl.
The ostomy appeared to be patent with no evidence of bleeding.
Ostomy appliance was placed.