[Solved]: Preoperative Diagnosis: Left strangulated inguinal…

Preoperative Diagnosis: Left strangulated inguinal hernia Postoperative Diagnosis: Left strangulated inguinal hernia Procedure: Repair of strangulated left inguinal hernia with mesh Procedure: This 45-year-old male was prepped in the usual manner for an initial hernia repair. After satisfactory spinal anesthesia, the inguinal area was draped in the usual sterile manner. A transverse incision was made above the inguinal ligament and carried down to the fascia of the external oblique, which was then opened, and the cord was mobilized. The ilioinguinal nerve was identified and protected. A relatively large indirect hernia was found. However, there was an extension of the hernia, such that one could definitely tell there had been a long-standing hernia here that probably had enlarged fairly recently. The posterior wall, however, was quite dilated and without a great deal of tone and bulging, and probably fit the criteria for a hernia by itself. Nonetheless, the hernia sac was separated from the cord structures, and a high ligation was done with a purse-string suture of 2-0 silk and a suture ligature of the same material prior to amputating the sac. The posterior wall was repaired with Marlex mesh, which was sewn in place in the usual manner, anchoring two sutures at the pubic tubercle tissue, taking one lateral up the rectus sheath and one lateral along the shelving border of Poupart’s ligament past the internal ring. The mesh had been incised laterally to accommodate the internal ring. Several sutures were used to tack the mesh down superiorly and laterally to the transversalis fascia. Then the two limbs of the mesh were brought together laterally to the internal ring and secured to the shelving border of Poupart’s ligament. The mesh was irrigated with gentamicin solution. The subcutaneous tissue was closed with fine Vicryl, as was the internal oblique. Marcaine was infiltrated in the subcutaneous tissue and skin. The wound was closed with fine nylon. The patient tolerated the procedure well. Pathology Report Gross Description Specimen: Hernia sac The specimen consists of a pink to blue-gray membranous piece of tissue measuring 5.5 cm in maximum dimension. Blocks are made. Clinical: Left strangulated inguinal hernia Assign the correct diagnosis and procedure codes: ICD-10-CM code: