sara0014
Contributor
Looking for assistants with capturing all of the CPT codes in this case.
PREOPERATIVE DIAGNOSIS: Rectal cancer, extensive.
POSTOPERATIVE DIAGNOSIS: Rectal cancer, extensive.
PROCEDURE: Laparotomy, sigmoid colostomy, Hartmann's pouch. Placement of a power port right subclavian catheter.
INDICATION: This lady has an extensive rectal carcinoma without obvious evidence of distant disease on her CT. She needs preop chemotherapy, radiation, and then a repeat surgical evaluation in Madison after her therapy to see if she is resectable. All of that has been explained to the patient a number of times in the last 10 days. I also sat down with her and her two sisters this morning and reviewed both procedures and stressed the fact that it is highly unlikely that she would ever have a Hartmann's takedown procedure because there won't be any distal rectum available. She is aware of standard complications of an exploratory laparotomy and a colostomy.
In the operating room, general anesthesia, 2 grams of IV methoxine. Chloraprep and appropriate draping after Foley catheter was placed.
We did a midline incision through her previous midline scar and entered her abdomen easily. A couple of omental adhesions were taken down. Sigmoid is very identifiable and nicely mobile. I explored her upper abdomen manually. No abnormalities noted. No ascites. No peritoneal studding down in the pelvis. Both ovaries are absolutely normal. The uterus is small and normal. Cecum is normal. We divided the sigmoid at its mid point, took down the mesenterial and then extracted that through a left mid rectus incision. It was tacked a couple of times on the inside with a few 3-0 Vicryl. We then did two sets of counts which were correct. Her midline was closed with running 0 Vicryl from above and below. Skin was stapled. Wound was protected. Her colostomy repaired with numerous interrupted 3-0 Vicryl. Blood loss due to this procedure 25 mL or less.
She was dressed appropriately and then we took down all of our material from the laparotomy, switched out everything and I prepped her chest and neck myself such that we could access both sides. A power port was placed on the right, one stick of fluoro to identify her wire which is appropriately placed followed by the catheter itself which was re fluoroed. Power port was placed inferiorly. The skin marked with a marker pen so that the nursing staff could identify the port. It is also very visible and then we flushed the catheter and re fluoroed as a final maneuver and everything is appropriate radiographically.
Both of her wounds were closed in layers with interrupted 3-0 Vicryl and there was skin over the port with a running 3-0 Vicryl. Steri-Strips applied. Blood loss due to this procedure 5-10 mL maximum. Complications none.
PREOPERATIVE DIAGNOSIS: Rectal cancer, extensive.
POSTOPERATIVE DIAGNOSIS: Rectal cancer, extensive.
PROCEDURE: Laparotomy, sigmoid colostomy, Hartmann's pouch. Placement of a power port right subclavian catheter.
INDICATION: This lady has an extensive rectal carcinoma without obvious evidence of distant disease on her CT. She needs preop chemotherapy, radiation, and then a repeat surgical evaluation in Madison after her therapy to see if she is resectable. All of that has been explained to the patient a number of times in the last 10 days. I also sat down with her and her two sisters this morning and reviewed both procedures and stressed the fact that it is highly unlikely that she would ever have a Hartmann's takedown procedure because there won't be any distal rectum available. She is aware of standard complications of an exploratory laparotomy and a colostomy.
In the operating room, general anesthesia, 2 grams of IV methoxine. Chloraprep and appropriate draping after Foley catheter was placed.
We did a midline incision through her previous midline scar and entered her abdomen easily. A couple of omental adhesions were taken down. Sigmoid is very identifiable and nicely mobile. I explored her upper abdomen manually. No abnormalities noted. No ascites. No peritoneal studding down in the pelvis. Both ovaries are absolutely normal. The uterus is small and normal. Cecum is normal. We divided the sigmoid at its mid point, took down the mesenterial and then extracted that through a left mid rectus incision. It was tacked a couple of times on the inside with a few 3-0 Vicryl. We then did two sets of counts which were correct. Her midline was closed with running 0 Vicryl from above and below. Skin was stapled. Wound was protected. Her colostomy repaired with numerous interrupted 3-0 Vicryl. Blood loss due to this procedure 25 mL or less.
She was dressed appropriately and then we took down all of our material from the laparotomy, switched out everything and I prepped her chest and neck myself such that we could access both sides. A power port was placed on the right, one stick of fluoro to identify her wire which is appropriately placed followed by the catheter itself which was re fluoroed. Power port was placed inferiorly. The skin marked with a marker pen so that the nursing staff could identify the port. It is also very visible and then we flushed the catheter and re fluoroed as a final maneuver and everything is appropriate radiographically.
Both of her wounds were closed in layers with interrupted 3-0 Vicryl and there was skin over the port with a running 3-0 Vicryl. Steri-Strips applied. Blood loss due to this procedure 5-10 mL maximum. Complications none.