Question

After admission to the hospital, the patient is a 21-day-old male who is brought to the operating room and general anesthesia induced. The child had been previously diagnosed with Hirschsprung's disease by a rectal biopsy that showed no ganglion cells. A left lower quadrant oblique incision was made and dissection continued with electrocautery until the peritoneal cavity was entered. A stool-filled sigmoid colon was identified and delivered into the wound, A small biopsy was taken from the sigmoid portion of the bowel and sent for frozen section. This was returned normal with normal numbers of ganglion cells. The colon was then tacked to the fascia and peritoneum using interrupted 4-0 silk suture. A #12 red-rubber catheter was placed through the mesentery of the colon and looped upon itself and sutured with 2-0 silk suture. The colostomy of the sigmoid colon was then opened using electrocautery and both the limbs were found to be widely patent through the fascia. The colostomy was brought to the cutaneous level and a colostomy bag was applied. The sponge, needle, and instrument counts were reported to be correct at the conclusion of the procedure. The child was awakened and taken to the recovery room in satisfactory condition. Principal Diagnosis: Secondary Diagnoses: Principal Procedure: Secondary Procedure(s):

Answer 1

8. Principle diagnosis- hirschsprung disease

principle procedure : colostomy

secondary procedure: rectal biopsy

9. principle diagnosis: cholecystitis

secondary diagnosis : elevated blood pressure

primary procedure: ultrasound abdomen