44021 Enterotomy, small intestine, other than duodenum; for decompression (eg, Baker tube)

Name of the Procedure:

Enterotomy, small intestine, other than duodenum; for decompression (e.g., Baker tube)

Summary

An enterotomy for decompression is a surgical procedure where an incision is made in the small intestine (excluding the duodenum) to relieve pressure and remove accumulated fluid or gas. A Baker tube may be used to assist in this decompression.

Purpose

• Medical Conditions: Bowel obstruction, severe intestinal bloating, or ileus.
• Goals: To relieve pressure in the intestine, alleviate symptoms such as pain and distention, and prevent complications like bowel ischemia or perforation.

Indications

• Severe abdominal distention and pain.
• Bowel obstruction not relieved by conservative measures.
• Symptoms of a severe ileus.
• Radiological evidence of a significant bowel dilation.

Preparation

• Fasting for 6-8 hours before the procedure.
• Adjustments to medications as directed by a physician.
• Pre-operative imaging studies (e.g., X-rays, CT scans) to locate the obstruction.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A surgical incision is made in the abdomen to access the small intestine.
3. Enterotomy: An incision is made in the distended segment of the small intestine.
4. Decompression: The fluid or gas causing the distention is removed, frequently using a Baker tube.
5. Closure: The incision in the intestine is sutured closed, and the abdominal incision is closed with sutures or staples.
6. Observation: The patient is closely monitored for any signs of complications.

Duration

Approximately 1-2 hours.

Setting

Typically performed in a hospital operating room.

Personnel

• Surgeon
• Anesthesiologist
• Operating room nurses
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Bleeding
• Injury to surrounding organs
• Leakage from the incision site in the intestine
• Postoperative ileus (temporary cessation of bowel function)

Benefits

• Relief from abdominal distention and pain
• Improved bowel function
• Prevention of serious complications such as bowel ischemia or perforation
• Symptom relief typically noticed immediately after the procedure

Recovery

• Hospital stay for a few days post-procedure.
• Gradual reintroduction of diet, starting with liquids and progressing to solids.
• Pain management with prescribed medications.
• Instructions on wound care and activity restrictions.
• Follow-up appointments to monitor recovery.

Alternatives

• Non-surgical decompression using nasogastric or rectal tubes.
• Medications to promote bowel movement.
• Watchful waiting in less severe cases.
• Comparatively, non-surgical methods may be less invasive but might be less effective in severe cases.

Patient Experience

• During the Procedure: Under general anesthesia, the patient will be asleep and feel no pain.
• After the Procedure: Some pain and discomfort at the incision site, managed with medications. Gradual improvement in symptoms of distention and bowel function. Close monitoring and supportive care in the hospital.

Pain management includes prescribed postoperative pain relief medications, and comfort measures such as positioning and wound care.