ggparker14
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Would like other opinions on CPTs for partial bladder resection and excision of colovesical fistula and closure of the bladder with a suprapubic cystostomy. Thanks for any help.
I was able to dissect the colon away from the posterior wall of the bladder entering large abscess cavity of about 4-5 cm. This abscess cavity eroded the posterior wall of the bladder. After separating the colon from the posterior wall of the bladder, the bladder was opened at the dome and carrried down to a fistulous tract which was intubated with a lacrimal duct proble. The area surrounding the abscess and the inflamed bladder was resected and a wedge resected, leaving clear normal bladder wall, inside the bladder, one bladder stone was removed and some fecal material was irrigated and removed. There was an indwelling Foley catheter which was left in place. An opening was made to the right of the dome of the bladder and a skin incision was made to the right of the abdominal incision bringing a new 25-French Foley catheter through the abdominal wall into a separate opening in the dome of the bladder. The bladder was then closed in three layers using 2-0 chromic running and interrupted suture, a portion of the omentum was brought down between the posterior wall of the bladder along the cystectomy closure incision and separating it from the colon anastomosis which will be dictated by another physician.
I was able to dissect the colon away from the posterior wall of the bladder entering large abscess cavity of about 4-5 cm. This abscess cavity eroded the posterior wall of the bladder. After separating the colon from the posterior wall of the bladder, the bladder was opened at the dome and carrried down to a fistulous tract which was intubated with a lacrimal duct proble. The area surrounding the abscess and the inflamed bladder was resected and a wedge resected, leaving clear normal bladder wall, inside the bladder, one bladder stone was removed and some fecal material was irrigated and removed. There was an indwelling Foley catheter which was left in place. An opening was made to the right of the dome of the bladder and a skin incision was made to the right of the abdominal incision bringing a new 25-French Foley catheter through the abdominal wall into a separate opening in the dome of the bladder. The bladder was then closed in three layers using 2-0 chromic running and interrupted suture, a portion of the omentum was brought down between the posterior wall of the bladder along the cystectomy closure incision and separating it from the colon anastomosis which will be dictated by another physician.