Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); with colostomy
CPT4 code
Name of the Procedure:
Suture of Large Intestine (Colorrhaphy) with Colostomy
Summary
This surgical procedure involves repairing a perforation (hole or tear) in the large intestine that can be caused by a perforated ulcer, diverticulum, wound, injury, or rupture. The surgeon sutures the perforations and also creates a colostomy, an opening in the abdominal wall to allow waste to bypass the damaged area of the colon and collect in a bag.
Purpose
The procedure addresses perforations in the large intestine which can lead to severe infection, peritonitis, and sepsis if untreated. The goals are to repair the damaged intestine, prevent infection, and allow the intestine to heal properly by diverting stool away from the sutured area.
Indications
- Severe abdominal pain and signs of infection due to perforated diverticula or ulcers.
- Trauma to the abdomen resulting in intestinal perforations.
- Radiation-induced injury.
- Conditions leading to rupture of the large intestine.
Preparation
- Fasting for at least 8 hours before surgery.
- Bowel preparation may be required.
- Pre-operative blood tests, imaging studies, and possible consultations with an anesthesiologist.
- Discussion of current medications with healthcare providers to manage adjustments.
Procedure Description
- Anesthesia: The patient is given general anesthesia.
- Incision: A surgical cut is made in the abdomen to access the large intestine.
- Suturing: The surgeon locates and sutures (stitches) the perforations in the intestine.
- Colostomy Creation: An opening (stoma) is created in the abdominal wall, and the healthy part of the colon is brought out through this stoma to allow waste to be collected in a colostomy bag.
- Closing: The abdominal incision is closed with sutures or staples.
- Post-Surgery Care: The patient is monitored in a recovery room before being transferred to a hospital room for further care.
Duration
Typically, the procedure takes 2-4 hours, depending on the complexity and number of perforations.
Setting
The procedure is performed in a hospital operating room.
Personnel
- General Surgeon
- Anesthesiologist
- Surgical Nurses
- Surgical Technicians
Risks and Complications
- Infection at the surgical site or within the abdomen.
- Bleeding or blood clots.
- Reaction to anesthesia.
- Leakage from sutured areas.
- Complications related to the colostomy, like stoma infection or hernia.
Benefits
- Effective treatment of perforated intestines, leading to relief from severe symptoms and prevention of life-threatening infections.
- Colostomy allows the bowel to heal by diverting stool away from the repaired area.
Recovery
- Hospital stay for several days post-surgery.
- Pain management with medications.
- Instructions for colostomy care and hygiene.
- Gradual reintroduction of diet as recommended by the healthcare provider.
- Avoid heavy lifting or strenuous activities for several weeks.
- Follow-up appointments to monitor healing and manage colostomy.
Alternatives
- Conservative management with antibiotics and bowel rest (less commonly effective in severe cases).
- Laparoscopic repair without colostomy (only in selected cases).
Patient Experience
- The patient will be under general anesthesia and will not feel anything during the surgery.
- Post-operative pain managed with medication.
- Temporary adjustment period for learning to manage the colostomy bag.
- Gradual improvement in symptoms and return to normal activities over weeks to months.