GSCoder07
Networker
Please help!! Am I thinking right on this one?!
I am stumped on this one. I'm thinking 44899 and 44120. Please, please help!!!
Op Report:
PREOPERATIVE DIAGNOSES:
1. Gastrointestinal bleeding.
2. Possible Meckel's diverticulum, distal small bowel.
POSTOPERATIVE DIAGNOSES: Large Meckel's diverticulum, distal small bowel.
OPERATION: Diagnostic laparoscopy with conversion to minimal laparotomy with
segmental small bowel resection to include a large Meckel's diverticulum.
OPERATIVE NOTE: The patient was brought to the operating room and under general
anesthesia was prepped and draped in the usual fashion over the anterior abdominal
wall; 0.25 percent Marcaine was instilled and a wheal was raised on the left lateral
abdomen about the umbilical area. Using a 5-mm Optiview port, this was placed
percutaneously into the abdomen under direct vision, and a pneumoperitoneum obtained.
I placed another 5-mm port in the left upper quadrant, one in the left lower
quadrant.
The cecum appeared normal. The patient had a large, kind of distended appendix, but
it was distended with air, I think, from his colonoscopy. I was able to follow the
distal ileum. We followed the distal ileum from the cecum proximal until we ran into
what appeared to be a huge Meckel's diverticulum or duplication cyst of some sort. I
was able to dissect this out pretty much, but I felt that we were going to probably
have to do a partial small bowel resection, so I elected to just make a small
infraumbilical incision and bring the bowel out and did a resection at that time.
So, I removed the trocars, made a small infraumbilical incision in the midline,
carried it down through the skin and subcutaneous tissues with electrocautery.
The midline fascia was opened. The peritoneum was opened, and the abdomen was
entered. We were able to bring this large duplication cyst up. It was kind of
bound down into the mesentery, and we dissected it free off the mesentery, and I
dissected quite a bit of it laparoscopically. This made kind of a Y in the bowel,
and what I decided to do was just place a GIA stapler proximal and distal to this
large Meckel's diverticulum, and I fired these. I then just resected the Meckel's
using the Harmonic scalpel by taking down the mesentery.
We then re-anastomosed the small bowel using a GIA stapler and a TA-90 in the usual
fashion. We repaired the mesenteric defect using a 3-0 running Vicryl, and I placed
a small suture at the crotch of the staples using a 3-0 sural muscular Vicryl.
Hemostasis was adequately obtained. We irrigated the operative site and the small
bowel. We then replaced the small bowel into the abdomen, closed the midline fascia
using a running, double-strength 1 PDS. The skin was closed with staples, and the
trocar sites were closed with staples.
The patient tolerated this procedure well.
Thanks so much for your help in advance!!
I am stumped on this one. I'm thinking 44899 and 44120. Please, please help!!! Op Report:
PREOPERATIVE DIAGNOSES:
1. Gastrointestinal bleeding.
2. Possible Meckel's diverticulum, distal small bowel.
POSTOPERATIVE DIAGNOSES: Large Meckel's diverticulum, distal small bowel.
OPERATION: Diagnostic laparoscopy with conversion to minimal laparotomy with
segmental small bowel resection to include a large Meckel's diverticulum.
OPERATIVE NOTE: The patient was brought to the operating room and under general
anesthesia was prepped and draped in the usual fashion over the anterior abdominal
wall; 0.25 percent Marcaine was instilled and a wheal was raised on the left lateral
abdomen about the umbilical area. Using a 5-mm Optiview port, this was placed
percutaneously into the abdomen under direct vision, and a pneumoperitoneum obtained.
I placed another 5-mm port in the left upper quadrant, one in the left lower
quadrant.
The cecum appeared normal. The patient had a large, kind of distended appendix, but
it was distended with air, I think, from his colonoscopy. I was able to follow the
distal ileum. We followed the distal ileum from the cecum proximal until we ran into
what appeared to be a huge Meckel's diverticulum or duplication cyst of some sort. I
was able to dissect this out pretty much, but I felt that we were going to probably
have to do a partial small bowel resection, so I elected to just make a small
infraumbilical incision and bring the bowel out and did a resection at that time.
So, I removed the trocars, made a small infraumbilical incision in the midline,
carried it down through the skin and subcutaneous tissues with electrocautery.
The midline fascia was opened. The peritoneum was opened, and the abdomen was
entered. We were able to bring this large duplication cyst up. It was kind of
bound down into the mesentery, and we dissected it free off the mesentery, and I
dissected quite a bit of it laparoscopically. This made kind of a Y in the bowel,
and what I decided to do was just place a GIA stapler proximal and distal to this
large Meckel's diverticulum, and I fired these. I then just resected the Meckel's
using the Harmonic scalpel by taking down the mesentery.
We then re-anastomosed the small bowel using a GIA stapler and a TA-90 in the usual
fashion. We repaired the mesenteric defect using a 3-0 running Vicryl, and I placed
a small suture at the crotch of the staples using a 3-0 sural muscular Vicryl.
Hemostasis was adequately obtained. We irrigated the operative site and the small
bowel. We then replaced the small bowel into the abdomen, closed the midline fascia
using a running, double-strength 1 PDS. The skin was closed with staples, and the
trocar sites were closed with staples.
The patient tolerated this procedure well.
Thanks so much for your help in advance!!
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