kajalgaonkar16
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POSTOPERATIVE DIAGNOSIS: Left hemothorax and left diaphragmatic injury,
laceration to the splenic flexure of the colon and omental bleeding.
PROCEDURE: Exploratory laparotomy, repair of diaphragmatic injury and repair
of colonic laceration and control of omental bleeding, as well as left chest
tube placement.
Patient was taken to the operating room.
Initially, he was prepped and draped on the left chest and a left chest tube
was placed in the usual fashion and secured with 0 silk sutures to the left
chest. Upon placing the chest tube there was approximately 300 mL of blood
that was evacuated. No further apparent bleeding was encountered. The
abdomen was then prepped and draped in the usual sterile fashion. A generous
midline laparotomy was then done. Upon entering the abdomen, there was
hemoperitoneum and the abdomen was packed in all quadrants. We began by
exploring the rest of the abdomen because we knew that there was injury in the
left upper quadrant. The small bowel was run from the ileocecal valve to the
ligament of Treitz and it was normal. The liver was normal. Right and left
colon descending and rectum were normal. We then turned our attention to the
left upper quadrant and the area of bleeding appeared to be from an omental
injury to some omental artery. This was controlled between clamps and 2-0
silk ties. We then mobilized the splenic flexure at the white line of Toldt
in the descending colon and taking this with electrocautery we mobilized the
splenic flexure in its entirety. There was a small 1.5 cm laceration of the
left colon without any contamination of the area except just air. This was
easily controlled with interrupted 2-0 silk as we dealt with the rest of the
injuries. There were some clots in the left upper quadrant. We were not sure
if the stomach was injured and therefore it was mobilized and the short
gastrics were taken between clamps. There appeared to be no injuries to the
stomach, either inferior or posterior walls. The spleen also was not injured
and the pancreas was also uninjured. We did find a 3 cm laceration of the
left diaphragm. This was controlled with interrupted figure-of-eight 0
Prolene sutures and this repaired this area. We then turned our attention
back to the colonic laceration. This was then repaired in layers of 2-0 and
3-0 silk Lembert sutures. There appeared to be no other injuries into the
abdomen and there was no active bleeding. The abdomen was then thoroughly
irrigated. The fascia was then closed with a #1 Vicryl on a CTX needle x 2
and the skin was then approximated with staples. We also prepped and draped
the lacerations in the left arm and the chest wall and these were repaired
with staples. The patient was extubated at the end of the procedure and he
tolerated the procedure well.
Am I right with using 39501, 44604?
Do I need to code control of omental bleeding too?
laceration to the splenic flexure of the colon and omental bleeding.
PROCEDURE: Exploratory laparotomy, repair of diaphragmatic injury and repair
of colonic laceration and control of omental bleeding, as well as left chest
tube placement.
Patient was taken to the operating room.
Initially, he was prepped and draped on the left chest and a left chest tube
was placed in the usual fashion and secured with 0 silk sutures to the left
chest. Upon placing the chest tube there was approximately 300 mL of blood
that was evacuated. No further apparent bleeding was encountered. The
abdomen was then prepped and draped in the usual sterile fashion. A generous
midline laparotomy was then done. Upon entering the abdomen, there was
hemoperitoneum and the abdomen was packed in all quadrants. We began by
exploring the rest of the abdomen because we knew that there was injury in the
left upper quadrant. The small bowel was run from the ileocecal valve to the
ligament of Treitz and it was normal. The liver was normal. Right and left
colon descending and rectum were normal. We then turned our attention to the
left upper quadrant and the area of bleeding appeared to be from an omental
injury to some omental artery. This was controlled between clamps and 2-0
silk ties. We then mobilized the splenic flexure at the white line of Toldt
in the descending colon and taking this with electrocautery we mobilized the
splenic flexure in its entirety. There was a small 1.5 cm laceration of the
left colon without any contamination of the area except just air. This was
easily controlled with interrupted 2-0 silk as we dealt with the rest of the
injuries. There were some clots in the left upper quadrant. We were not sure
if the stomach was injured and therefore it was mobilized and the short
gastrics were taken between clamps. There appeared to be no injuries to the
stomach, either inferior or posterior walls. The spleen also was not injured
and the pancreas was also uninjured. We did find a 3 cm laceration of the
left diaphragm. This was controlled with interrupted figure-of-eight 0
Prolene sutures and this repaired this area. We then turned our attention
back to the colonic laceration. This was then repaired in layers of 2-0 and
3-0 silk Lembert sutures. There appeared to be no other injuries into the
abdomen and there was no active bleeding. The abdomen was then thoroughly
irrigated. The fascia was then closed with a #1 Vicryl on a CTX needle x 2
and the skin was then approximated with staples. We also prepped and draped
the lacerations in the left arm and the chest wall and these were repaired
with staples. The patient was extubated at the end of the procedure and he
tolerated the procedure well.
Am I right with using 39501, 44604?
Do I need to code control of omental bleeding too?