Remvoval of intraluminal gallstone with enterotomy


Kenner, LA
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Should I use 44020 or 44615?


Patient was brought into the operating room and placed on the operating table in supine position. The abdomen was prepped and draped in sterile fashion, entered through a vertical midline incision, extending just above and below the umbilicus. Electrocautery was used to dissect through the subcutaneous tissue down to the fascia, which was opened in the midline. Upon entering the abdomen, there was about 300-400 cc of serous, slightly cloudy fluid. This was cultured, it was completely evacuated. The bowel was dilated. The small bowel was completely eviscerated. The liver was smooth and healthy. There was an inflammatory process in and around a small, contracted gallbladder which appeared chronic. There were no masses in the ascending, transverse, descending colon. The NG tube was palpated in the stomach. The small bowel was run from the ligament of Treitz. In the mid jejunum there was some edema and erythema in patches of the bowel wall, but no areas of ischemia. In the mid ileum there was a transition zone with about a 2cm intraluminal gallstone. Distal to this, the bowel was collapsed down to the ileocecal valve. The small bowel was run multiple times. There were no other palpable intraluminal masses. The gallstone was milked proximally into an area of noninflamed bowel. A tranverse enterotomy was made. There was no spillage of enteric contents. The gallstone was removed. The enterotomy was closed transversely with an inner layer of 3-0 Vicryl and an outer layer of 3-0 silk Lembert sutures. There was no leakage from the anastomosis. There was narrowing of the lumen. There was also a small serosal tear just about 6 inches proximal to this. This was imbricated with 3-0 silk Lembert sutures. The abdomen was inspected. It was found to be hemostatic. There were no other enterotomies. The abdomen was copiously irrigated with normal saline. The returned fluid was clear. The small bowel was reduced into the abdomen. The fascia was closed with a running #2 nylon. The wound was irrigated with normal saline. The skin was closed with staples.