percutaneous endoscopic debridement of liver abscess


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Hoping for Help. I code for a General Surgeon who performed the procedure with IR. I am thinking unlisted.

Location: Angiography suite.( Procedure done in conjunction with Dr S [interventonal radiology])

After informed consent was obtained, the patient was brought to the IR suite and placed in the supine position. She was prepped and draped in the usual sterile fashion. The existing hepatic drain was removed and a guidewire was placed. First the small procedural endoscope was placed and the cavity was visualized. The cavity was flushed with saline numerous times. A small biopsy forceps was used to debride by removing material in piecemeal fashion. The endoscope was then upsized to standard endoscope to optimize viewing of the cavity. We used the Raptor forceps, the pronged Grasping forceps and the biopsy forceps with multiple passes. The cavity was flushed and hemostasis was satisfactory. The scope was removed and Dr S proceeded with the remainder of the catheter change.

Findings: Friable granulation tissue with large amounts of fibrinous exudate lining the liver abscess cavity with no overt pus. No bile seen. There was at the cephalad position a smaller second cavity contiguous with the main tract and cavity, which seemed to contain more fibrinous material. No necrotic liver material encountered.

Thanks in advance!