Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open
CPT4 code
Name of the Procedure:
Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open (Also known as Open Peritoneal Abscess Drainage)
Summary
In simple terms, this procedure involves making an incision in the abdomen to drain pus from an abscess in the peritoneal cavity (the space within the abdomen housing the intestines and other abdominal organs). This helps to treat an infection in the abdominal cavity that has not spread from an appendiceal abscess.
Purpose
The procedure aims to treat an abdominal infection and prevent it from spreading or causing more serious complications. Draining the abscess removes infected fluid, alleviates pain, and reduces inflammation to promote healing.
Indications
- Severe abdominal pain and tenderness
- Fever and signs of infection not responsive to antibiotics
- Imaging studies (e.g., CT scan, ultrasound) confirming presence of a peritoneal abscess
- Symptoms of localized peritonitis (inflammation of the peritoneum)
Preparation
- Fasting: The patient will need to stop eating and drinking several hours before the procedure.
- Medication adjustments: Blood thinners and other medications may need to be suspended or adjusted as per doctor’s instructions.
- Pre-procedure tests: Blood tests, imaging studies, and sometimes an ECG to assess overall health and readiness for surgery.
Procedure Description
- Anesthesia: General anesthesia is administered so the patient is asleep and pain-free during the procedure.
- Incision: The surgeon makes an incision in the abdominal wall, close to the site of the abscess.
- Drainage: The abscess is located and the pus is drained using suction or sterile sponges.
- Cleaning: The surgical area is irrigated with saline to ensure all infected material is removed.
- Closure: The incision is closed with sutures or staples, and sometimes a drain is left in place to continue draining any residual fluid.
Duration
The procedure typically takes between 1 to 2 hours, depending on the complexity and size of the abscess.
Setting
This procedure is performed in a hospital’s operating room under sterile conditions.
Personnel
- Surgeon
- Surgical nurses
- Anesthesiologist
- Operating room technician
Risks and Complications
- Infection at the incision site
- Bleeding
- Injury to nearby organs
- Risks associated with anesthesia
- Formation of new abscesses
- Prolonged ileus (temporary lack of bowel movement)
Benefits
- Relief from severe pain and fever
- Reduction in infection and inflammation
- Prevention of the spread of infection
- Improved abdominal function and overall health
Recovery
- Hospital stay: A few days hospitalization may be required for monitoring and recovery.
- Post-procedure care: Pain management with prescribed medications, wound care instructions, and maintaining the drainage tube if one is placed.
- Activity restrictions: Limited physical activity until the wound heals.
- Follow-up: Scheduled appointments to monitor progress, remove sutures/drain, and ensure the infection has resolved.
Alternatives
- Percutaneous drainage (less invasive, guided by imaging)
- Antibiotic therapy alone (may be ineffective for larger abscesses)
- Laparoscopic drainage (minimally invasive option, if suitable)
Pros and Cons of Alternatives:
- Percutaneous drainage: Less invasive, faster recovery but may be less effective for large/deep abscesses
- Antibiotic therapy: Non-invasive but may not suffice without drainage
- Laparoscopic drainage: Minimally invasive, faster recovery, but not suitable for all patients
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel pain. Post-operatively, they may experience pain at the incision site, managed with pain medications. Patients will be encouraged to move around after surgery to prevent complications such as blood clots, although activity will be restricted until the wound heals. Close monitoring and follow-up care are crucial for a smooth recovery.