ksb0211
Guest
I'm just trying to figure out where to start with this one. One coder has it as a hernia repair and lysis of adhesions...which doesn't work for me. Maybe I'm wrong, but I would just like another coder's opinion. Thanks.
PREOPERATIVE DIAGNOSIS
Small bowel obstruction.
POSTOPERATIVE DIAGNOSIS
Small bowel obstruction secondary to internal herniation of the small bowel.
... An incision was made above the umbilicus and we got into the abdominal cavity and then extended our incision downward after making some blunt dissection removing some of the surrounding omentum from the abdominal wall. Once we had done that we opened the incision up and carried out our dissection. We found distended gut proximally and collapsed gut distally. As we carried our dissection we could see that what was causing this obstruction was a loop of small bowel that had become adhesed forming a ring through which other small bowel had herniated through closing it and forming an internal herniation. At this point we carried out dissection. As we completed our dissection, we realized that there was a lot of dense adhesions down the left lower quadrant where the patient had a previous tumor and radiation therapy. We were not sure if we had gotten everything up, but we actually did and so we went ahead and were able to get the gut mobilized in its entirety. We irrigated with a lot of saline containing and Ancef aspirated and then carefully reordered the small bowel back in its normal anatomic position and then covered it with some surrounding omentum. We then closed with double stranded #1 PDS, but not before placing on On-Q pain pump into position through the fascia into the posterior rectus sheath bilaterally. Once that was done we closed with double stranded #1 PDS, irrigated the wound, then closed with a few sutures of 3-0 Vicryl and then with skin staples. The patient tolerated the procedure quite well.
PREOPERATIVE DIAGNOSIS
Small bowel obstruction.
POSTOPERATIVE DIAGNOSIS
Small bowel obstruction secondary to internal herniation of the small bowel.
... An incision was made above the umbilicus and we got into the abdominal cavity and then extended our incision downward after making some blunt dissection removing some of the surrounding omentum from the abdominal wall. Once we had done that we opened the incision up and carried out our dissection. We found distended gut proximally and collapsed gut distally. As we carried our dissection we could see that what was causing this obstruction was a loop of small bowel that had become adhesed forming a ring through which other small bowel had herniated through closing it and forming an internal herniation. At this point we carried out dissection. As we completed our dissection, we realized that there was a lot of dense adhesions down the left lower quadrant where the patient had a previous tumor and radiation therapy. We were not sure if we had gotten everything up, but we actually did and so we went ahead and were able to get the gut mobilized in its entirety. We irrigated with a lot of saline containing and Ancef aspirated and then carefully reordered the small bowel back in its normal anatomic position and then covered it with some surrounding omentum. We then closed with double stranded #1 PDS, but not before placing on On-Q pain pump into position through the fascia into the posterior rectus sheath bilaterally. Once that was done we closed with double stranded #1 PDS, irrigated the wound, then closed with a few sutures of 3-0 Vicryl and then with skin staples. The patient tolerated the procedure quite well.
