I need some help coding hemostatic sutures at a cornual pregnancy site. Here is a copy of the OP report. Any thoughts would be appreciated.
PREOPERATIVE DIAGNOSIS: SUSPECTED RUPTURED ECTOPIC PREGNANCY
POSTOPERATIVE DIAGNOSIS:
1.RUPTURED LEFT CORNUAL ECTOPIC PREGNANCY
2.RUPTURED RIGHT CORPUS LUTEUM CYST
PROCEDURE PERFORMED:
EXPLORATORY LAPAROTOMY WITH HEMOSTATIC SUTURES AT CORNUAL PREGNANCY SITE
DESCRIPTION OF PROCEDURE IN DETAIL: The patient was taken to the operating room where general anesthesia was found to be adequate. She was then prepped and draped in a dorsal supine position.
A Pfannenstiel skin incsion was made with a scalpel and carried through the underlying layer of fascia with the Bovie. The fascia was incised in the midline and the incision extended laterally with the Bovie. The superior aspect of the fascial incisionwas grasped with Kocher clamp, elevate, the underlying rectus muscles dissected off with the Bovie. The inferior aspect of the fascial incision was grasped with the Kocher clamp,elevated and he underlying rectus muscle dissected off with the Bovie. The rectus muscles were separated in the midline. The peritoneum was identified and entered bluntly. The peritoneal incision was extended superiorly and inferiorly.
At this time, it was noted that multiple blood clots were in the abdomen with the total number overall during the whole procedure of 1.5mL of hemoperitoneum being evacuated. After vigorous irrigation was completed and removal of hemoperitoneum was completed, an O'Connor-O'Sullivan retractor was entered into the abdomen. At this time, the uterus was identified and grasped with the lemon squeezer and brought to the incsion. The left cornual region of the uterus was noted to have a 1.5cm defect that was bleeding due to a ruptured ectopic pregnancy. At this time, utilizing 2-0 Vicryl, hemostatic stitches were applied to this region and excellent hemostatis was obtained.
Attention was then turned to the right ovary which appeared to have a right corpus luteum cyst that had ruptured. The area appeared hemostatic. Again, vigorous irrigation was done to the abdomen. Gutters were cleared of all clots and debris. Uterus was returned to the abdomen. The muscles were closed with 2-0 Vicryl in a running fashion. Fascia was closed with 0 Vicryl in a running fashion. The skin was closed with 4-0 Vicryl in subcuticular fashion. The patient tolerated the procedure well. Sponge, lap and needle counts were correct x2.
PREOPERATIVE DIAGNOSIS: SUSPECTED RUPTURED ECTOPIC PREGNANCY
POSTOPERATIVE DIAGNOSIS:
1.RUPTURED LEFT CORNUAL ECTOPIC PREGNANCY
2.RUPTURED RIGHT CORPUS LUTEUM CYST
PROCEDURE PERFORMED:
EXPLORATORY LAPAROTOMY WITH HEMOSTATIC SUTURES AT CORNUAL PREGNANCY SITE
DESCRIPTION OF PROCEDURE IN DETAIL: The patient was taken to the operating room where general anesthesia was found to be adequate. She was then prepped and draped in a dorsal supine position.
A Pfannenstiel skin incsion was made with a scalpel and carried through the underlying layer of fascia with the Bovie. The fascia was incised in the midline and the incision extended laterally with the Bovie. The superior aspect of the fascial incisionwas grasped with Kocher clamp, elevate, the underlying rectus muscles dissected off with the Bovie. The inferior aspect of the fascial incision was grasped with the Kocher clamp,elevated and he underlying rectus muscle dissected off with the Bovie. The rectus muscles were separated in the midline. The peritoneum was identified and entered bluntly. The peritoneal incision was extended superiorly and inferiorly.
At this time, it was noted that multiple blood clots were in the abdomen with the total number overall during the whole procedure of 1.5mL of hemoperitoneum being evacuated. After vigorous irrigation was completed and removal of hemoperitoneum was completed, an O'Connor-O'Sullivan retractor was entered into the abdomen. At this time, the uterus was identified and grasped with the lemon squeezer and brought to the incsion. The left cornual region of the uterus was noted to have a 1.5cm defect that was bleeding due to a ruptured ectopic pregnancy. At this time, utilizing 2-0 Vicryl, hemostatic stitches were applied to this region and excellent hemostatis was obtained.
Attention was then turned to the right ovary which appeared to have a right corpus luteum cyst that had ruptured. The area appeared hemostatic. Again, vigorous irrigation was done to the abdomen. Gutters were cleared of all clots and debris. Uterus was returned to the abdomen. The muscles were closed with 2-0 Vicryl in a running fashion. Fascia was closed with 0 Vicryl in a running fashion. The skin was closed with 4-0 Vicryl in subcuticular fashion. The patient tolerated the procedure well. Sponge, lap and needle counts were correct x2.