Question
Could you kindly help me find the codes for these? Chief Complaint (CC): Previous diverticular disease of colon. History of Present Illness (HPI): Had anterior
Could you kindly help me find the codes for these?
Chief Complaint (CC):
Previous diverticular disease of colon.
History of Present Illness (HPI):
Had anterior resection, colostomy for diverticular disease.
Past Surgical History (PSH):
Anterior resection. Tonsils.
Procedure name:
Closure Hartmann colostomy. Repair of small bowel enterotomy.
Description of procedure:
Under satisfactory general anesthesia, in the lithotomy position, the patient was prepped and draped in the usual manner. The previous midline incision was used and carried down to the subcutaneous tissues. It was quite scarred. We entered into the abdominal cavity and found the small bowel adhered to the anterior abdominal wall. This was carefully taken down however, the lower end of the incision had opened the small bowel. The small bowel was then freed and this was repaired in 2 layers with 3-0 Vicryl suture and 3-0 Surgilon sutures. We then continued to explore the abdomen. The end of the distal colon was identified and we then took down the stoma, excising an ellipse of skin. The stoma was then dissected out of the fascial defect and into the abdominal cavity. We then attempted to pass the stapler, but we felt that because the distal end was quite acutely angulated posteriorly, we would not have much success getting the stapler around this and we abandoned this approach and elected to sew the anastomosis. the stoma was then cleared. We chose a point in the large bowel just proximal to the stoma site. The mesentery was serially clamped, cut, and tied with 2-0 Vicryl suture. The stoma was then excised and passed off. There was good blood supply to this end of the bowel. We then further freed the distal end of the colon. We dissected back to the rectum. We then divided this bowel. An end-to-end anastomosis was then fashioned in a hand-sewn method using 2 layers. There was no tension on the anastomosis. A good lumen was identified that lay nicely in the pelvis. The abdomen was then thoroughly irrigated with warm normal saline until the returns were clear. There were 1 or 2 small bleeding points in the omentum, which were clamped, cut, and tied with 2-0 Vicryl suture. The omentum was then laid down over the bowel. A 10 mm Jackson-Pratt drain was introduced through a separate stab incision to the right of the main incision and placed down in the pelvis. The abdomen was closed in 1 layer with running #1 PDS suture. The skin was approximated with interrupted stainless steel skin staples. The drain was sutured in place with 2-0 black silk and a dry dressing was applied. At the end of the procedure, the sponge, needle, and instrument count was reported correct. The patient was awakened and transferred to the recovery room in satisfactory condition. The blood loss during the procedure was approximately 250 mL.
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