I am having the hardest time coding this report. Could someone please help?

Reason For Study: SMALL BOWEL OBSTRUCTION

History: A 55-year-old male with small bowel obstruction. He has had total colectomy. Over the past 15 years, he has been emptying his small bowel with a 29 French red rubber catheter. There has been kinking at the distal end of the ileostomy.

Under Fluoro stopping guidance, a 26 French red rubber catheter was unable to negotiate the kink of the ileostomy. Therefore, a 20 French red rubber catheter was utilized. This was able to loop around the kink into the contralateral side, the left side. Contrast injection showed a large amount of ileal contents with distended ileum. Minimal amount of contents was able to the massage out through the catheter into a Foley bag. Therefore a stiff Glidewire was used to exchange the 20 French red rubber catheter for a 26 French red rubber catheter. The larger lumen of the 26 French catheter was able to drain a large amount of ileal content corresponding to 2 liters over a 60 minute drainage manipulation procedure. Numerous images were obtained. At the end of the procedure, the catheter is seen loops within the pelvis with markedly improved small bowel appearance in the abdomen as a result of decompression of the distal ileum.

At the end of the procedure, the red rubber catheter was left in place connected to a fresh Foley bag and this was secured with 2 inches silk tape attached to the skin.


Impression:

1. A kink at the ileostomy site prevents a catheter are larger than 20 French from negotiated the kink.

2. After 20 French catheter was placed around the kink, a stiff Glidewire was used to straighten the catheter and exchange the catheter for a 26 French catheter.

3. Slow 60 minutes external intermittent pressure of the distal ileum was able to remove 2 liters of ileal content. This resulted in marked reduction of small bowel lumen diameter.