Question

INPATIENT HOSPITAL Gender: M Age: 15

Preprocedure assessment: Presented to ED with vomiting, acute abdominal pain, RLQ tenderness, T 101 degrees

Procedure description: Appendectomy. Made three small umbilical incisions and placed laparoscope. Expanded abdominal cavity with carbon dioxide to aid visualization. Grasped appendix and divided with stapler. Cauterized appendiceal stump. Removed appendix, irrigated and suctioned abdominal cavity. Removed instruments and closed incision. Patient tolerated procedure well, no complications.

Postprocedure diagnosis: Acute appendicitis with rupture

1. What is the stated procedure?

  

2. What organ or body part is involved?

  

3. Is the procedure description what you would expect based on the name of the procedure?

  

4. Was more than one procedure, or a combined procedure, performed?

  

5.Review the Key Criteria for Abstracting Root Operations. To which question did you answer yes?

  

6.Review the definitions of the root operations that answer this question. Which root operation correctly describes this procedure?

  

7. Review the Key Criteria for Abstracting the Approach. What surgical approach is used?

Answer 1

Ans :

1. Stated procedure:

Appendectomy. Made three small umbilical incisions and placed laparoscope. Expanded abdominal cavity with carbon dioxide to aid visualization. Grasped appendix and divided with stapler. Cauterized appendiceal stump. Removed appendix, irrigated and suctioned abdominal cavity. Removed instruments and closed incision. Patient tolerated procedure well, no complications.

2. Body part involved :

Appendix

3. An appendectomy, also termed appendicectomy, is a surgical operation in which the vermiform appendix is removed. Appendectomy is normally performed as an urgent or emergency procedure to treat complicated acute appendicitis. Appendectomy may be performed laparoscopically or as an open operation

4.

1.General anaesthesia is induced, with endotracheal intubation and full muscle relaxation, and the patient is positioned supine.

2.The abdomen is prepared and draped and is examined under anesthesia.

3.If a mass is present, the incision is made over the mass. Otherwise, the incision is made over McBurney's point (one-third of the way from the anterior superior iliac spine to the umbilicus), which represents the most common position of the base of the appendix.

4.The various layers of the abdominal wall are opened. In order to preserve the integrity of abdominal wall, the external oblique aponeurosis is split along the line of its fibers, as is the internal oblique muscle. As the two run at right angles to each other, this reduces the risk of later incisional hernia.

5.On entering the peritoneum, the appendix is identified, mobilized, and then ligated and divided at its base.

6.Some surgeons choose to bury the stump of the appendix by inverting it so it points into the caecum.

7.Each layer of the abdominal wall is then closed in turn.

5.You won't find an appendectomy in ICD-10-PCS, but you will need to know that the cutting out or off, without replacement, of an entire body part is a resection. Since an appendectomy typically involves the removal of the entire appendix, resection is the correct root operation

6.appendectomy

7.