maxwell@marshall.edu
Contributor
Please see the following:
History--MVA car vs. coal truck
Pt brought to operating room and placed on table in supine position. Abdomen rapidly prepped and draped. Chest tubes were placed to suction reapid midline incision was made....Upone entering the abdomen pt had several adjension in lower abd and up over liver. these were rapidly taken down. packs were placed in the abd and a balfour retractor was placed. it was noted pt had a large mesenteric injury within the distal small bowel. clamps were placed on this and packs were also placed in all four quadrants. initially did a resection of the disttal small bowel with several firings of the GIA. in the mesentery there was hematoma and bleeding from this torn mesentery. this was suture ligated which seemed to stop the bleeding. there was only a very small portion of terminal ileum that was left. we then turned attention down to the left lower quadrant where there appeared to be some bleeding. the whole distal colon in the left lower quadrant over the iliac wing had been completely ripped up. there was bleeding deep down withing the pelvis and a hematoma down there. we were unable to identifiy the ureter but we did see two vessels that were actively pumping. these were clamped and suture ligated, we did not visualize the ureter due to the damage in the retroperitoneum. the colon was then divided over this area of mesenteric injury. the retroperitoneum over the entire iliac wing was completely de serosalized and we were palpating the iliac wing. there did not appear to be a gracture. we revisted the small bowel there was only about 1 cm proximal o the ileocecal valve and this was in the cecum had a hematoma, serosal tear. we therefore mobilized up the cecum, divied the colon just at the level of the cecum, suture ligated the vessels in thes area, we then performed a side to side functional end to end anastomosis using the stapler......the patient had massive resuscitation by anesthesia and appeared hemodynamicall stable but due to the long portion of the case pt was coagulopathic and we felt we should pack the abdomen open with plans to bring pt back in a couple days to perform a colostomy.
I'm thinking 44140 and 44150 with 52 modifier. Any one have any other idea..
Thank you
History--MVA car vs. coal truck
Pt brought to operating room and placed on table in supine position. Abdomen rapidly prepped and draped. Chest tubes were placed to suction reapid midline incision was made....Upone entering the abdomen pt had several adjension in lower abd and up over liver. these were rapidly taken down. packs were placed in the abd and a balfour retractor was placed. it was noted pt had a large mesenteric injury within the distal small bowel. clamps were placed on this and packs were also placed in all four quadrants. initially did a resection of the disttal small bowel with several firings of the GIA. in the mesentery there was hematoma and bleeding from this torn mesentery. this was suture ligated which seemed to stop the bleeding. there was only a very small portion of terminal ileum that was left. we then turned attention down to the left lower quadrant where there appeared to be some bleeding. the whole distal colon in the left lower quadrant over the iliac wing had been completely ripped up. there was bleeding deep down withing the pelvis and a hematoma down there. we were unable to identifiy the ureter but we did see two vessels that were actively pumping. these were clamped and suture ligated, we did not visualize the ureter due to the damage in the retroperitoneum. the colon was then divided over this area of mesenteric injury. the retroperitoneum over the entire iliac wing was completely de serosalized and we were palpating the iliac wing. there did not appear to be a gracture. we revisted the small bowel there was only about 1 cm proximal o the ileocecal valve and this was in the cecum had a hematoma, serosal tear. we therefore mobilized up the cecum, divied the colon just at the level of the cecum, suture ligated the vessels in thes area, we then performed a side to side functional end to end anastomosis using the stapler......the patient had massive resuscitation by anesthesia and appeared hemodynamicall stable but due to the long portion of the case pt was coagulopathic and we felt we should pack the abdomen open with plans to bring pt back in a couple days to perform a colostomy.
I'm thinking 44140 and 44150 with 52 modifier. Any one have any other idea..
Thank you