CPT® Code 44661

An enterovesical fistula is defined as an abnormal connection that forms between a segment of the intestine and the urinary bladder. This condition can arise due to various underlying issues, with diverticular disease of the colon being the most prevalent cause. Other significant contributors include colon cancer, inflammatory bowel diseases such as Crohn's disease, complications resulting from radiation therapy, or trauma to the abdominal area. The surgical procedure associated with CPT® Code 44661 involves a comprehensive approach to address this abnormal communication. During the operation, the abdomen is surgically opened to locate the fistulous tract. Once identified, the tract is carefully divided, allowing for the separation of the bowel and bladder. A thorough examination of the tract is conducted to assess whether the affected bowel and bladder can be repaired through primary closure or if resection is necessary. In cases where resection is indicated, the fistulous tract is severed, and the bowel is clamped above and below the affected area. The segment containing the fistulous tract is then removed, followed by an end-to-end anastomosis to rejoin the bowel. If bladder resection is required, the fistulous tract is excised along with a portion of the bladder wall, which is subsequently reapproximated with sutures. Additionally, to mitigate the risk of recurrence, a separately reportable omental flap may be created and positioned between the bowel and bladder. The procedure concludes with the placement of drains in the abdominal cavity and the closure of the abdominal incision.