45334 vs 45339
Sigmoidoscopy with control of hemorrhage (ablation via Argon plasma
1. Midazolam 5 mg IV.
2. Fentanyl 75 mcg IV.
DETAILS OF THE PROCEDURE:
History was reviewed and examination was performed. A time-out was
performed. Medications were reconciled. Informed consent was obtained.
The patient's last dialysis was on Monday, and he will go after our
procedure for dialysis this evening in . After cardiopulmonary
status was assessed and satisfactory, medications were administered
intravenously and titrated to above doses to achieve light to moderate
sedation. Once sedated, a Pentax gastroscope was advanced via the anus to
the sigmoid colon at 40 cm of insertion. He tolerated the procedure well.
Fresh red blood was seen at up to 25 cm of insertion. It was clear
proximal to this up to 40. We washed all blood, which appears to be
back-wash from the rectum where there is angiodysplastic appearing lesions
consistent with radiation proctopathy. These were within the last 5 cm of
the rectum. 1 of these was oozing. Using the ERBE via APC rectal protocol
settings, APC was used to assist control of hemorrhage and ablate other
lesions. The 3 larger angiodysplastic lesions, 1 of which was oozing, were
ablated. Smaller lesions closer to the dentate line were ablated, some
about the line, and minimal APC was performed there to minimize discomfort
of the patient. The scope was removed, the procedure terminated without
any immediate complications.
1. Radiation proctopathy.
2. Argon plasma coagulation ablation of most all lesions.
3. Control of hemorrhage from bleeding lesion.
1. Await response to therapy.
2. Repeat p.r.n. if bleeding recurs (minimal bleeding from time to time
should not spur concerns to the patient).
3. The patient has agreed prior to the procedure and in the discharge
instructions, with the driver to go for hemodialysis tonight, and not delay