abyrne
Networker
I'm looking for help on coding the following OP note as I'm not very familiar with Vascular coding. So any help would be greatly appreciated.
I was called emergently about a potential vascular injury.
When I came to the operating room, the abdomen had been opened by the general surgery service and the retractor was in place.
There was a slowly expanding retroperitoneal hematoma.
FINDINGS:
I extended the incision and placed a supraceliac clamp. We then dove into the retroperitoneal hematoma. I quickly moved the clamp to the infrarenal aorta.
We found the injury at the level of the right common iliac artery.
I was able to clamp the common iliac artery at the aortic bifurcation and at the iliac bifurcation.
I transected the artery and freshened the edges and was able to primarily repair it.
At the termination of the case, both of her feet were well-perfused.
DESCRIPTION OF PROCEDURE:
I was called emergently.
When I arrived, the abdomen was open. I began by removing the abdominal protector. I extended the incision to the xiphoid process. I continued down through the subcutaneous tissue and opened the fascia. We placed the self-retaining retractor. I took down the triangular ligament of the liver. We quickly performed an abdominal exploration and evaluated the large retroperitoneal hematoma. Because I did not know where the injury was, I decided to place the supraceliac clamp.
I found the crura of the diaphragm and found the NG tube and the aorta. I bluntly dissected around the aorta and placed a clamp. The pressure immediately improved
We then took down the ligament of Treitz. I then compartmentalized the transverse colon cephalad and the small bowel to the right side of the abdomen.
We then opened the retroperitoneum with the Bovie and bluntly. We found the inferior vena cava and aorta. It was clear that the injury was more distal.
I moved the clamp to the infrarenal aorta and took off the supraceliac clamp.
I then continued my dissection and ultimately was able to dissected out the distal aorta, left common iliac, right common iliac, and right iliac bifurcation.
I clamped the left common iliac just distal to the aortic bifurcation and clamped the right common iliac just proximal to the external/internal iliac bifurcation. I heparinized the patient
I found the hole at the level of the right common iliac artery. I examined it. I transected the artery with the Potts scissors. I freshened up the edges. I had excellent antegrade and retrograde bleeding. I then proceeded to primarily repair the artery with a 5-0 Prolene in a parachute fashion. I backbled all vessels prior to completing the anastomosis. I did place 1 repair suture. There was excellent hemostasis. We were able to Doppler pulses in both of her feet. I discussed the case with the surgeons in the room. She still needs her hysterectomy. At this time, she is too unstable. I recommended essentially a "damage control" laparotomy. We make sure she is metabolically optimized and then return tomorrow for hysterectomy and abdominal closure.
I copiously irrigated out the abdomen. I ensured hemostasis in the retroperitoneum. I did reverse the heparin with protamine
I also ensured hemostasis in the supraceliac clamp area
I irrigated all 4 abdominal quadrants
I was satisfied that there was no further surgical bleeding
I then placed the ABThera wound VAC and it had excellent suction
She returned to the ICU.
I was called emergently about a potential vascular injury.
When I came to the operating room, the abdomen had been opened by the general surgery service and the retractor was in place.
There was a slowly expanding retroperitoneal hematoma.
FINDINGS:
I extended the incision and placed a supraceliac clamp. We then dove into the retroperitoneal hematoma. I quickly moved the clamp to the infrarenal aorta.
We found the injury at the level of the right common iliac artery.
I was able to clamp the common iliac artery at the aortic bifurcation and at the iliac bifurcation.
I transected the artery and freshened the edges and was able to primarily repair it.
At the termination of the case, both of her feet were well-perfused.
DESCRIPTION OF PROCEDURE:
I was called emergently.
When I arrived, the abdomen was open. I began by removing the abdominal protector. I extended the incision to the xiphoid process. I continued down through the subcutaneous tissue and opened the fascia. We placed the self-retaining retractor. I took down the triangular ligament of the liver. We quickly performed an abdominal exploration and evaluated the large retroperitoneal hematoma. Because I did not know where the injury was, I decided to place the supraceliac clamp.
I found the crura of the diaphragm and found the NG tube and the aorta. I bluntly dissected around the aorta and placed a clamp. The pressure immediately improved
We then took down the ligament of Treitz. I then compartmentalized the transverse colon cephalad and the small bowel to the right side of the abdomen.
We then opened the retroperitoneum with the Bovie and bluntly. We found the inferior vena cava and aorta. It was clear that the injury was more distal.
I moved the clamp to the infrarenal aorta and took off the supraceliac clamp.
I then continued my dissection and ultimately was able to dissected out the distal aorta, left common iliac, right common iliac, and right iliac bifurcation.
I clamped the left common iliac just distal to the aortic bifurcation and clamped the right common iliac just proximal to the external/internal iliac bifurcation. I heparinized the patient
I found the hole at the level of the right common iliac artery. I examined it. I transected the artery with the Potts scissors. I freshened up the edges. I had excellent antegrade and retrograde bleeding. I then proceeded to primarily repair the artery with a 5-0 Prolene in a parachute fashion. I backbled all vessels prior to completing the anastomosis. I did place 1 repair suture. There was excellent hemostasis. We were able to Doppler pulses in both of her feet. I discussed the case with the surgeons in the room. She still needs her hysterectomy. At this time, she is too unstable. I recommended essentially a "damage control" laparotomy. We make sure she is metabolically optimized and then return tomorrow for hysterectomy and abdominal closure.
I copiously irrigated out the abdomen. I ensured hemostasis in the retroperitoneum. I did reverse the heparin with protamine
I also ensured hemostasis in the supraceliac clamp area
I irrigated all 4 abdominal quadrants
I was satisfied that there was no further surgical bleeding
I then placed the ABThera wound VAC and it had excellent suction
She returned to the ICU.