Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; multiple perforations
CPT4 code
Name of the Procedure
Suture of Small Intestine (Enterorrhaphy) for perforated ulcer, diverticulum, wound, injury, or rupture; multiple perforations.
Summary
Enterorrhaphy is a surgical procedure to repair holes or tears in the small intestine. This might be required due to ulcers, diverticula, injuries, or ruptures. The surgeon stitches the perforations, aiming to restore the integrity of the small intestine.
Purpose
This procedure addresses severe damage to the small intestine, which could be life-threatening without intervention. The goals are to close the perforations, prevent further contamination of the abdominal cavity, and restore normal intestinal function.
Indications
Patients needing this procedure usually present with:
- Severe abdominal pain.
- Symptoms of peritonitis (e.g., fever, rigid abdomen).
- Evidence of perforation on imaging studies.
- Trauma to the abdomen resulting in intestinal wounds.
Preparation
- Patients must fast for at least 8 hours before the surgery.
- Pre-operative clearance might include blood tests, imaging studies (like CT scans), and sometimes an endoscopy.
- Adjusting or stopping certain medications (like blood thinners) might be necessary one week prior.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: An incision is made to access the abdominal cavity.
- Identification: The surgeon identifies and isolates the perforated areas.
- Suture: The perforations are cleaned and stitched closed using sutures appropriate for intestinal tissue.
- Inspection: The abdomen is inspected for any other injuries or sources of contamination.
- Closure: The abdomen is washed out to prevent infection, and the incision is closed.
Tools and equipment include surgical scalpels, suturing needles, and specialized retractors. Advanced imaging might be used for precise localization.
Duration
The procedure typically takes 2-4 hours, depending on the number and complexity of perforations.
Setting
Enterorrhaphy is performed in a hospital's operating room.
Personnel
- Lead Surgeon
- Surgical Nurses
- Anesthesiologist
- Surgical Technicians
Risks and Complications
- Common risks: Infection, bleeding, and adverse reactions to anesthesia.
- Rare risks: Bowel obstruction, leakage at sutures, and fistula formation.
- Possible complications: Severe infections such as peritonitis, requiring additional interventions.
Benefits
The primary benefit is the reduced risk of serious infection and restoration of normal digestive tract function. Improvement often begins within a few days, with full recovery taking several months.
Recovery
- Initial post-operative care in the hospital for 5-7 days.
- Gradual reintroduction of oral intake.
- Instructions on wound care, antibiotics, and scheduled follow-up appointments.
- Full recovery may take 6-8 weeks, with restrictions on heavy lifting and vigorous activities.
Alternatives
- Conservative Management: In rare cases, small perforations might seal by non-surgical means but carry higher risks.
- Laparoscopic Surgery: Less invasive but might not be suitable for all cases.
- Resection with Anastomosis: Involves removal of damaged sections and connecting healthy portions, typically for extensive damage.
Patient Experience
During the procedure, patients will be under general anesthesia and feel no pain. Post-operatively, mild to moderate pain can be expected, managed through pain relief medication. Discomfort from the surgical site and some mobility restrictions will be present, with a gradual return to normal activities. Comfort measures include proper positioning, wound care, and appropriate diet adjustments.