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Thread: Multiple colon resections colostomy's (HELP)

  1. #1

    Default Multiple colon resections colostomy's (HELP)

    AAPC: Back to School
    Hello. I would love any advice on this one. I am looking at
    But what about code 44160.......
    Am I even warm on this one?????


    PREOPERATIVE DIAGNOSIS: Acute sigmoid diverticulitis.

    1. Exploratory laparotomy.
    2. Sigmoid colon resection.
    3. Right hemicolectomy.
    4. Mobilization of splenic flexure.
    5. Ileostomy.
    6. Colostomy.
    7. Mucus fistula.

    1. Acute sigmoid diverticulitis with abscess.
    2. Perforated cecum.

    Patient is a 37-year-old gentleman who recently was admitted to the
    hospital for an episode of diverticulitis. Discharged on oral antibiotics
    which he did not complete the course. He was then readmitted for the same.
    He appeared to have a stricture in his sigmoid colon. He developed a small
    bowel obstruction and was then taken to the operating room after
    conservative measures failed for treatment of his diverticulitis.

    After informed consent was obtained, the patient was taken to the operating
    room and placed supine on the table. General anesthesia was administered.
    The patient's abdomen was then prepped and draped in sterile fashion. The
    patient was then placed in lithotomy position. A generous midline incision
    was made and carried down through the skin and subcutaneous tissues until
    the fascia was reached. The fascia was incised in the midline. The
    abdominal cavity was then explored. There were numerous adhesions of the
    small bowel to the pelvis at this area of inflammation, causing the
    subsequent small bowel obstruction. The small bowel was very edematous. I
    evaluated the cecum. It was markedly dilated and did have an area of
    necrosis. We then evaluated the sigmoid colon. There was a very dense
    inflamed mass with omentum adherent. I then identified a distal resection
    margin and then fired the contour stapler across this and mobilized the
    colon from its lateral attachments, both with blunt and sharp dissection.
    I then divided it proximally. The mesentery was then divided with the
    ligature device. As there was not going to be enough mobilization for a
    tension-free ostomy, I then mobilized the splenic flexure without any
    difficulty using electrocautery and the ligature device. There was a large
    amount of stool present within the colon. The colon was markedly dilated.
    I then re-evaluated this patient's right colon where again the right colon
    was mobilized along the line of Toldt up around the hepatic flexure. I
    then identified the distal resection margin with what appeared to be viable
    colon. I then divided this again with the contour stapler. I also divided
    the terminal ileum with contour stapler. The mesentery was then divided
    with __________ ligature device. It appeared that the best option for the
    patient at this time would be to do an ileostomy and mucous fistula as well
    as colostomy. I then made 2 elliptical incisions in the patient's lower
    quadrants and carried these down through the skin and subcutaneous tissues
    until the fascia was reached. A cruciate incision was made in the fascia,
    and I then dilated through with 3 fingers. The sigmoid colon was brought
    through the left defect ileum and proximal colon was brought through the
    right. These were secured with Babcock clamps. We did try to evacuate
    some of the stool in doing this to help facilitate closure as well as
    maturation of the stomas. After adequate hemostasis had been achieved and
    adequate irrigation had been performed, I then placed a Jackson-Pratt drain
    in the patient's pelvis. I then closed the fascia with looped 0 Biosyn
    suture. The skin was then closed with surgical staples. A dressing was
    applied. Both the ileostomy and the colostomy were matured in the standard
    fashion with 3-0 Vicryl suture. The mucous fistula was performed just
    adjacent to the ostomy, and a 22-French red rubber catheter was placed
    within this to provide for antegrade irrigation. Ostomy appliances were
    applied. A Jackson-Pratt drain was sewn in place with a 3-0 nylon suture.
    The patient tolerated the procedure well. There were no complications.
    The patient was transferred to the recovery room intubated and in guarded

  2. #2
    Join Date
    Apr 2007

    Red face multiple colon resection

    I recently had the same challenge. I would use 44141, 44160,59 and 44139.
    Hope this helps.

  3. #3


    Thank you so much for your reply!!!!! I submitted as you suggested, Thanks!

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