drhoads
Guru
Procedure: Exploratory laparotomy, lysis of adhesions, drainage of abdominal wall abscess with debridement, drainage of intra-abdominal abscess, repair of pancreaticojejunostomy anastomosis and left subclavian central line.
The pt had undergone a Whipple 2 weeks ago. She began with a copious amount of drainage for her Chevron incision. She has a large amount of pannus. A left subclavian triple lumen catheter was placed via Seldinger technique. The previous Chevron incision had already been mostly open. The remainder of the staples were removed. The fascial sutures were removed and generous debridemnet of the large amount of subcutaneous tissue and necrotic fascia was was performed using a combination of electrocautery and Mayo scissors. There was a generous amount of subcutaneous tissue. It appeared that there was pus coming from underneath the fascia. It was a yellowish, fatty, part bilious, part saponified debris coming up from the depths fo the wound. As such, lysis of adhesions was performed to the rather matted loops of bowel just underneath the fascia and down to expose the liver. I could see the prior leiver biopsy. I got into the abscess collection with my sucker. Following the abscess cavity down, the base of which was the pancreaticojejunostomy anastomosis, I could see the silk sutures which were almost in the breeze, the plastic stent and the 5-french umbilical catheter which was stenting eh pancreatic duct and the anastomosis. This was removed and was replaced with an 8-french red rubber catheter with multiple side holes. The attempt was to reconnect the mucosal approximation, but with the abscess being there the pancreas really did not take stitches well. Attemplt was made on the left with 7-9 double-armed cardiovascular prolene. Did the best we could to reapproximate extremely tenuous tissue. I then placed maximum Davol sump drain through a separate stab incision in the anterior abdomen over that region and along the anterior portion where the abscess had come up to the fascia. The other anastomosis were not visually inspected, but had no evidence of leak, Her G-tubs waas removed and exchanged for an 18-french foley catheter which was secured with 2-0 prolene and allowed to decompress. The fascial wound was then completely debrided of necrotic tissue and irrigated copiously with saline and clorpactin. It was then reapproximated as best I could with a few interrupted fascial sutures. Then the subcutanessue was packed with two 4-inch klings and 2 SBDs
Could anyone one agree with cpt 48545, 10180 and 36556??
The pt had undergone a Whipple 2 weeks ago. She began with a copious amount of drainage for her Chevron incision. She has a large amount of pannus. A left subclavian triple lumen catheter was placed via Seldinger technique. The previous Chevron incision had already been mostly open. The remainder of the staples were removed. The fascial sutures were removed and generous debridemnet of the large amount of subcutaneous tissue and necrotic fascia was was performed using a combination of electrocautery and Mayo scissors. There was a generous amount of subcutaneous tissue. It appeared that there was pus coming from underneath the fascia. It was a yellowish, fatty, part bilious, part saponified debris coming up from the depths fo the wound. As such, lysis of adhesions was performed to the rather matted loops of bowel just underneath the fascia and down to expose the liver. I could see the prior leiver biopsy. I got into the abscess collection with my sucker. Following the abscess cavity down, the base of which was the pancreaticojejunostomy anastomosis, I could see the silk sutures which were almost in the breeze, the plastic stent and the 5-french umbilical catheter which was stenting eh pancreatic duct and the anastomosis. This was removed and was replaced with an 8-french red rubber catheter with multiple side holes. The attempt was to reconnect the mucosal approximation, but with the abscess being there the pancreas really did not take stitches well. Attemplt was made on the left with 7-9 double-armed cardiovascular prolene. Did the best we could to reapproximate extremely tenuous tissue. I then placed maximum Davol sump drain through a separate stab incision in the anterior abdomen over that region and along the anterior portion where the abscess had come up to the fascia. The other anastomosis were not visually inspected, but had no evidence of leak, Her G-tubs waas removed and exchanged for an 18-french foley catheter which was secured with 2-0 prolene and allowed to decompress. The fascial wound was then completely debrided of necrotic tissue and irrigated copiously with saline and clorpactin. It was then reapproximated as best I could with a few interrupted fascial sutures. Then the subcutanessue was packed with two 4-inch klings and 2 SBDs
Could anyone one agree with cpt 48545, 10180 and 36556??