CPT® Code 45563

The procedure described by CPT® Code 45563 involves the exploration, repair, and presacral drainage for a rectal injury, specifically when a colostomy is also performed. This procedure is indicated in cases of penetrating injuries to the rectum, where the integrity of the rectal wall is compromised. The process begins with an abdominal exploration to identify the rectal injury, followed by controlling any bleeding that may be present. The rectal wound is then meticulously repaired using sutures to restore the normal anatomy. In instances where the injury necessitates a diversion of stool, a colostomy is created. This colostomy is typically fashioned from the sigmoid colon and serves to temporarily redirect fecal matter away from the rectum, allowing for healing. The colostomy can be performed using various techniques, including a loop colostomy, a loop colostomy with distal closure, or an end colostomy with a mucous fistula. After the abdominal procedure and the creation of the stoma, presacral drains are placed to facilitate drainage and prevent complications. The surgical approach includes making a curvilinear incision between the coccyx and the posterior margin of the anus, extending through the endopelvic fascia, and utilizing blunt dissection to access the presacral space and the site of the rectal injury. A drain is then inserted and secured to the perianal skin to ensure proper management of the surgical site.