CPT® Code 44605

Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); with colostomy

Suture repair of the large intestine, known as colorrhaphy, is a surgical procedure aimed at addressing various conditions that result in perforations of the large intestine. This procedure is specifically indicated for cases involving perforated ulcers, diverticula, wounds, injuries, or ruptures, which can lead to significant complications if not treated promptly. During the operation, a surgical incision is made in the abdomen to access the affected segment of the large intestine. The surgeon carefully removes the damaged portion and places it on the operating table for further manipulation. To ensure a safe and effective repair, intestinal contents are expressed from the segment, and the area is clamped above and below the perforation to control the flow of intestinal material. Bleeding control is a critical aspect of the procedure, achieved through the suture ligation of any involved blood vessels. The repair itself involves meticulously closing the opening in the intestine by suturing the mucous membranes first, followed by the serous coat, and finally the muscular wall, ensuring a robust closure to prevent future complications. After the repair, the abdominal cavity is thoroughly cleansed using gauze and irrigation fluid as necessary to minimize the risk of infection. Depending on the clinical scenario, drains may be placed to facilitate fluid management, and the abdominal incision is subsequently closed. In cases where a colostomy is required, the colon is divided above the site of the colorrhaphy. The colostomy procedure involves creating a stoma, which is an opening on the abdominal wall for the passage of intestinal contents. This is accomplished by making a small incision at the planned colostomy site, excising fat down to the anterior rectus fascia, and carefully opening the fascia while protecting the underlying muscle and its blood supply. The rectus fibers are separated using blunt dissection, and the peritoneum is entered to create an opening for the stoma. A peritoneal tunnel may also be established to prevent postoperative obstruction. Finally, the colon is brought through the abdominal wall, everted, and sutured to the skin, completing the colostomy creation. This comprehensive approach ensures that both the repair of the perforation and the colostomy are performed effectively, addressing the patient's immediate surgical needs.