My Dr said he did an Intestinal bypass, ileal transverse Colostomy
not sure if thats right. I need help coding this surgery please.
Was prepped and draped in usual sterile fashion. Midline incision was made in the upper abdomen and carried down to the fascia with electrocautery. Four liters of malignant ascites was immediately evacuated. The NG tube was felt to be in stomach. It was then repositioned to maximize its effect. We then eviscerated the small bowel, it was adherent down to the right lower quadrant where the previous ileocolostomy has been performed and the cecum had been removed. I could feel the carcinomatosis into the pelvis and on the small bowel in that area. I extended the incision below the umbilicus in order to provide exposure. It was clear that the previous are of surgery had recurrent carcinomatosis in it and into the pelvic floor, as well as the surrounding bowel. Both the right colon and the distal ileum were covered in carcinomatosis-type metastases. The liver was full of metastases as well. The transverse colon, descending, sigmoid and rectum were free of cancer. The distal ileum approximately 15 cm to 20cm proximal to the obstruction was brought up to the mid transverse colon and a functional end-to-end stapled anastomosis was ceated with the GIA-75 and a TA-60. there was an excellent connection between the small bowel and the mid transverse colon. The small bowel was returned to the abdominal cavity. The fascia was reapproximated with looped PDS. The wound was irrigated, skin was closed with staples and dressings were applied. The patient was extubated and transferred to recovery room in stable condition.
DX= Small bowel obstruction
DX= colong carcinoma with liver metastases.
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