I am thinking 44388, 45330-51. any suggestions or insight would be greatly appreciated.


INDICATIONS: History of colon cancer. This is a 45-year-old,
African-American female with a history of colon cancer. She is status-post
a left hemicolectomy and Hartman's pouch operation in 2008, and returns
here for a screening colonoscopy prior to planned reanastomosis. The
patient had previously presented for colonoscopy, however, had a tight
stricture ostomy, precluding colonoscopic exam. The patient was admitted
to the hospital under general surgery service yesterday and underwent
serial dilations with a Hagar dilator, to a maximum diameter of 18-French.

INSTRUMENT: Olympus neonatal ultra thin endoscope.

TECHNIQUE: Informed consent for a colonoscopy was obtained from the
patient, after all risks and benefits were explained and all questions answered. The patient was placed first supine for examination of her proximal colon through the strictured ostomy Due to the fact that the patient's ostomy was only able to be dilated to an 18-French diameter, this precluded us performing the examination using the gastroscope or a colonoscope. As a result, we had to resort to using the neonatal endoscope. We successfully navigated through the ostomy with the ultra thin endoscope into the cecum. Identification of the cecum made by ileocecal valve, appendiceal orifice and crows feet appearance. The endoscope was then slowly withdrawn, mucosa was carefully examined. After completion of exam of the proximal colon, the patient was placed in the left lateral decubitus position and the exam of the distal colon was made through the rectum, using the same endoscope.

FINDINGS: In the proximal colon, there was a small polyp in the proximal
transverse colon that was sessile, but not removed secondary to the use of
the ultra thin endoscope. No other polyps or large masses seen in the
proximal colon. On exam of the distal colon, views were somewhat obscured
by small amount of residual barium/defecated stool in the distal colon,
however, no large masses were seen. There were 2 small, rectosigmoid
polyps that were diminutive in size, noted upon withdrawal of the
endoscope. The anastomosis of the distal colon was measured at 35 cm.