Alfaro33
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44320 provided by MD does not seem to capture all services performed.
Preoperative Diagnosis Obstructing Rectal Mass
Postoperative Diagnosis Same
Indication for Surgery Patient admitted with abdominal pain and found to have obstructing rectal mass. Rectal mass unable to be passed by colonoscope. Biopsy with adenocarcinoma. Patient recommended low anterior resection with diverting ostomy due to the obstruction. Risk, benefits and alternatives to treatment discussed with patient. All questions answered. Agrees to proceed.
Operation Exploratory Laparotomy
Diverting Loop Sigmoid Colostomy
Excisional Biopsy Para-Aortic Lymph Node
Anesthesia General Endotracheal Anesthesia
Estimated Blood Loss 30 cc
Findings 1) Rectal Mass too low for low anterior resection
2) Diverting Loop Sigmoid Colostomy to resolve obstruction
3) Biopsy of Para aortic lymph node
Specimen Para aortic Lymph Node
Complications None
Description of Procedure Patient was brought in the operating room. Patient was placed in a lithotomy position. All pressure points were padded. Preoperative Antibiotics were given. General Endotracheal Anesthesia was provided by the Anesthesia team. The abdomen was then prepped and draped in the usual sterile fashion. A timeout was performed and the surgical site was verified. We began with a midline laparotomy. Exploration of the abdomen revealed paraaortic lymphadenopathy and a distal rectal mass. The rectal mass was at the level of the anal verge and not amenable to low anterior resection. We then excised a para-aortic lymph node for pathology. We then performed a diverting loop sigmoid colostomy. We mobilize the line of Toldt in order to have tension free colostomy. We then identified a ostomy site in the left lower quadrant. The ostomy site was create via muscle splitting technique. We then passed the sigmoid colon through the ostomy site. We then closed the midline with 1 PDS for the fascia and staples for the skin and a preveena dressing was applied. The colostomy was then matured in a brook fashion with 3.0 vicryl. Patient tolerated procedure well. Patient was extubated and transferred to PACU.
Preoperative Diagnosis Obstructing Rectal Mass
Postoperative Diagnosis Same
Indication for Surgery Patient admitted with abdominal pain and found to have obstructing rectal mass. Rectal mass unable to be passed by colonoscope. Biopsy with adenocarcinoma. Patient recommended low anterior resection with diverting ostomy due to the obstruction. Risk, benefits and alternatives to treatment discussed with patient. All questions answered. Agrees to proceed.
Operation Exploratory Laparotomy
Diverting Loop Sigmoid Colostomy
Excisional Biopsy Para-Aortic Lymph Node
Anesthesia General Endotracheal Anesthesia
Estimated Blood Loss 30 cc
Findings 1) Rectal Mass too low for low anterior resection
2) Diverting Loop Sigmoid Colostomy to resolve obstruction
3) Biopsy of Para aortic lymph node
Specimen Para aortic Lymph Node
Complications None
Description of Procedure Patient was brought in the operating room. Patient was placed in a lithotomy position. All pressure points were padded. Preoperative Antibiotics were given. General Endotracheal Anesthesia was provided by the Anesthesia team. The abdomen was then prepped and draped in the usual sterile fashion. A timeout was performed and the surgical site was verified. We began with a midline laparotomy. Exploration of the abdomen revealed paraaortic lymphadenopathy and a distal rectal mass. The rectal mass was at the level of the anal verge and not amenable to low anterior resection. We then excised a para-aortic lymph node for pathology. We then performed a diverting loop sigmoid colostomy. We mobilize the line of Toldt in order to have tension free colostomy. We then identified a ostomy site in the left lower quadrant. The ostomy site was create via muscle splitting technique. We then passed the sigmoid colon through the ostomy site. We then closed the midline with 1 PDS for the fascia and staples for the skin and a preveena dressing was applied. The colostomy was then matured in a brook fashion with 3.0 vicryl. Patient tolerated procedure well. Patient was extubated and transferred to PACU.