jcoder1
Contributor
I need help. Can you please read Op report. I was thinking of coding either 44605-78or 44320-78. The return to the OR was on the same day as the primary procedure. I am new to Gastro coding and if anyone has any suggestions on any coding books that would help, I would greatly appreciated it. I was thinking of Supercoder- Gastro.
Thanks
PROCEDURES PERFORMED:
1. Exploratory laparotomy.
2. Takedown of colorectal anastomosis.
3. Control of hemorrhage.
4. End-colostomy with rectal pouch.
FINDINGS: There was clot and blood in the left iliac fossa and pelvic side
wall, were all the raw surface was from the dissection of the sigmoid
phlegmon. This was impossible to completely expose without taking down the
anastomosis to evacuate the clot and the anastomosis was also at risk from
it bulging anteriorly from this process. Once the clot and blood was
evacuated, hemostasis is achieved from the raw surface area with the
application of Surgicel and an end colostomy and rectal pouch were formed.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room
via stretcher, placed on the operating table in supine position,
compression boots were placed. General endotracheal anesthesia was
instituted and the abdomen was prepped and draped in the usual fashion. A
final time-out was performed. The staples were were removed, the fascial
closure was removed and the abdomen was entered with both blood and clot
evident in the left lower quadrant and mostly throughout the abdomen. This
was all suctioned out. There was red bleeding nonpulsatile from beneath
the descending colon in the area of the colorectal anastomosis. Several
attempts at evacuating the clot could not identify the area of the bleeding
and the anastomosis was actually bulging forward from the blood and the
clot. It was now elected to take down the anastomosis to control the
hemorrhage. A contour stapler with the green load was applied just distal
to the anastomosis and fired on the rectal pouch dividing this area and
allowing the descending colon to be mobilized cephalad. This allowed
complete exposure to the left iliac fossa and pelvic side wall, allowing
the rest of the clot to be completely evacuated. There was no overt
bleeder that would be ligated. This area was irrigated and suctioned dry
and Surgicel was applied to the entire raw surface area and pressure was
held until the hemostasis was found to be complete. An 0 Prolene suture
was used to tag either end of the rectal pouch staple line and the rectal
pouch staple line was further run with an 0 Prolene suture. This was
placed back into the pelvis. All the irrigant was suctioned dry. It now
appeared that all the raw surface area which is now covered with Surgicel
and pressure applied appeared to be hemostatic. The left line of Toldt was
further mobilized towards the splenic flexure to further mobilized the
descending colon, and a circular area of skin in the left lower quadrant
was excised for the planned colostomy. The subcutaneous fat was removed
with the Bovie cautery and a cruciate incision was made in the anterior
rectus sheath fascia. The left rectus muscle was bluntly divided. The
posterior sheath and peritoneum were also entered in a cruciate fashion
with the Bovie cautery, allowing two finger best to pass through the
colostomy wound. A Babcock clamp was placed from the outside and grasp the
end of the descending colon and brought it out through the colostomy
incision without twisting it, holding it in place with a Babcock. An NG
tube had been passed. At this point, the left iliac fossa was once again
inspected and appeared to be hemostatic with all sponge, lap, needle and
instrument counts reported as correct. The omentum was placed down into
the pelvis and the midline fascia was closed using two running looped one
PDS sutures to the midline fascia. The subcutaneous tissues were irrigated
and midline skin was closed with staples. The colostomy was now matured to
the skin edges by excising the staple line at the end of the descending
colon by maturing the colostomy with multiple sutures of 3-0 Vicryl. Dry
sterile dressing was placed on the midline and colostomy appliance in the
left lower quadrant colostomy. The patient delivered to recovery room in
stable and satisfactory condition suffering no complications from the
procedure.
Thanks
PROCEDURES PERFORMED:
1. Exploratory laparotomy.
2. Takedown of colorectal anastomosis.
3. Control of hemorrhage.
4. End-colostomy with rectal pouch.
FINDINGS: There was clot and blood in the left iliac fossa and pelvic side
wall, were all the raw surface was from the dissection of the sigmoid
phlegmon. This was impossible to completely expose without taking down the
anastomosis to evacuate the clot and the anastomosis was also at risk from
it bulging anteriorly from this process. Once the clot and blood was
evacuated, hemostasis is achieved from the raw surface area with the
application of Surgicel and an end colostomy and rectal pouch were formed.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room
via stretcher, placed on the operating table in supine position,
compression boots were placed. General endotracheal anesthesia was
instituted and the abdomen was prepped and draped in the usual fashion. A
final time-out was performed. The staples were were removed, the fascial
closure was removed and the abdomen was entered with both blood and clot
evident in the left lower quadrant and mostly throughout the abdomen. This
was all suctioned out. There was red bleeding nonpulsatile from beneath
the descending colon in the area of the colorectal anastomosis. Several
attempts at evacuating the clot could not identify the area of the bleeding
and the anastomosis was actually bulging forward from the blood and the
clot. It was now elected to take down the anastomosis to control the
hemorrhage. A contour stapler with the green load was applied just distal
to the anastomosis and fired on the rectal pouch dividing this area and
allowing the descending colon to be mobilized cephalad. This allowed
complete exposure to the left iliac fossa and pelvic side wall, allowing
the rest of the clot to be completely evacuated. There was no overt
bleeder that would be ligated. This area was irrigated and suctioned dry
and Surgicel was applied to the entire raw surface area and pressure was
held until the hemostasis was found to be complete. An 0 Prolene suture
was used to tag either end of the rectal pouch staple line and the rectal
pouch staple line was further run with an 0 Prolene suture. This was
placed back into the pelvis. All the irrigant was suctioned dry. It now
appeared that all the raw surface area which is now covered with Surgicel
and pressure applied appeared to be hemostatic. The left line of Toldt was
further mobilized towards the splenic flexure to further mobilized the
descending colon, and a circular area of skin in the left lower quadrant
was excised for the planned colostomy. The subcutaneous fat was removed
with the Bovie cautery and a cruciate incision was made in the anterior
rectus sheath fascia. The left rectus muscle was bluntly divided. The
posterior sheath and peritoneum were also entered in a cruciate fashion
with the Bovie cautery, allowing two finger best to pass through the
colostomy wound. A Babcock clamp was placed from the outside and grasp the
end of the descending colon and brought it out through the colostomy
incision without twisting it, holding it in place with a Babcock. An NG
tube had been passed. At this point, the left iliac fossa was once again
inspected and appeared to be hemostatic with all sponge, lap, needle and
instrument counts reported as correct. The omentum was placed down into
the pelvis and the midline fascia was closed using two running looped one
PDS sutures to the midline fascia. The subcutaneous tissues were irrigated
and midline skin was closed with staples. The colostomy was now matured to
the skin edges by excising the staple line at the end of the descending
colon by maturing the colostomy with multiple sutures of 3-0 Vicryl. Dry
sterile dressing was placed on the midline and colostomy appliance in the
left lower quadrant colostomy. The patient delivered to recovery room in
stable and satisfactory condition suffering no complications from the
procedure.