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Please advise with proper codes. Thanks in advance!!!
PREOPERATIVE DIAGNOSIS:
1. Abdominal wall abscess.
2. Peritoneal abscess with suspected Hartmann pouch disruption.
POSTOPERATIVE DIAGNOSIS:
1. Abdominal wall abscess.
2. Peritoneal abscess with Hartmann pouch disruption.
OPERATION PERFORMED:
1. Incision and drainage of abdominal wall abscess with removal of abdominal
wall mesh and abdominal wall reconstruction using xenograft mesh.
2. Incision and drainage of peritoneum with large-bowel resection.
ANESTHESIA:
General plus local.
DESCRIPTION OF OPERATION:
The patient is on therapeutic IV antibiotic. DVT prophylaxis consisted of
subcu heparin and pneumatic compression stockings. The patient was placed
under general anesthesia after informed consent was obtained. An orogastric
tube and Foley catheter were placed. The abdomen was prepped and draped in the
usual fashion. The left upper quadrant ostomy was left open. The ostomy bag
was covered with an impervious plastic drape prior to the prep. Next, an
oblique incision was made over the previous left groin incision. Immediately
underneath the subcu tissue, there was foul-smelling anaerobic abscess
collection. Aerobic and anaerobic cultures were obtained. The area was
irrigated profusely with saline and Dakin solution. The abscess cavity was in
continuity with existing chronic mesh. This was taken down by careful sharp
dissection. The cord structures were granulated and were left alone. After
the mesh was removed, reconstruction was performed using Cook biologic
xenograft mesh and running PDS suture. The wound was irrigated with additional
saline. A Jackson-Pratt drain was placed over the mesh and brought out through
the left lower quadrant. The wound was closed with running interrupted Vicryl.
The skin was left open.
Next, a midline incision was made in the lower abdomen. The lower pelvis was
entered. An abscess cavity was found in the left lower quadrant. This was
also anaerobic in gross appearance. Cultures of this were obtained and labeled
"peritoneum." At the base of the abscess cavity, the Hartmann pouch was easily
mobilized and its staple line was seen to be disrupted. Two inches of Hartmann
pouch was prepared and divided with the firing of a GIA stapler and oversewn
with Vicryl Lembert sutures. The abdomen was irrigated with additional saline
and a drain was placed at this location of the abscess cavity, exiting the
abdomen in the right lower quadrant. The abdominal wall fascia was closed with
running looped #1 PDS. The subcutaneous tissues were reapproximated with
running Vicryl. Portions of the wound were closed with staples. Portions were
left open. The open wounds in the left lower quadrant and the midline were
then packed with Betadine gauze. The patient tolerated the procedure well.
All needle, sponge, and instrument counts were correct x2.
PREOPERATIVE DIAGNOSIS:
1. Abdominal wall abscess.
2. Peritoneal abscess with suspected Hartmann pouch disruption.
POSTOPERATIVE DIAGNOSIS:
1. Abdominal wall abscess.
2. Peritoneal abscess with Hartmann pouch disruption.
OPERATION PERFORMED:
1. Incision and drainage of abdominal wall abscess with removal of abdominal
wall mesh and abdominal wall reconstruction using xenograft mesh.
2. Incision and drainage of peritoneum with large-bowel resection.
ANESTHESIA:
General plus local.
DESCRIPTION OF OPERATION:
The patient is on therapeutic IV antibiotic. DVT prophylaxis consisted of
subcu heparin and pneumatic compression stockings. The patient was placed
under general anesthesia after informed consent was obtained. An orogastric
tube and Foley catheter were placed. The abdomen was prepped and draped in the
usual fashion. The left upper quadrant ostomy was left open. The ostomy bag
was covered with an impervious plastic drape prior to the prep. Next, an
oblique incision was made over the previous left groin incision. Immediately
underneath the subcu tissue, there was foul-smelling anaerobic abscess
collection. Aerobic and anaerobic cultures were obtained. The area was
irrigated profusely with saline and Dakin solution. The abscess cavity was in
continuity with existing chronic mesh. This was taken down by careful sharp
dissection. The cord structures were granulated and were left alone. After
the mesh was removed, reconstruction was performed using Cook biologic
xenograft mesh and running PDS suture. The wound was irrigated with additional
saline. A Jackson-Pratt drain was placed over the mesh and brought out through
the left lower quadrant. The wound was closed with running interrupted Vicryl.
The skin was left open.
Next, a midline incision was made in the lower abdomen. The lower pelvis was
entered. An abscess cavity was found in the left lower quadrant. This was
also anaerobic in gross appearance. Cultures of this were obtained and labeled
"peritoneum." At the base of the abscess cavity, the Hartmann pouch was easily
mobilized and its staple line was seen to be disrupted. Two inches of Hartmann
pouch was prepared and divided with the firing of a GIA stapler and oversewn
with Vicryl Lembert sutures. The abdomen was irrigated with additional saline
and a drain was placed at this location of the abscess cavity, exiting the
abdomen in the right lower quadrant. The abdominal wall fascia was closed with
running looped #1 PDS. The subcutaneous tissues were reapproximated with
running Vicryl. Portions of the wound were closed with staples. Portions were
left open. The open wounds in the left lower quadrant and the midline were
then packed with Betadine gauze. The patient tolerated the procedure well.
All needle, sponge, and instrument counts were correct x2.