| text_id subject object text relation_type sentence sft_re | |
| 383_TL0 ADMISSION 4/17/95 ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . OVERLAP [@Subject$]ADMISSION[@Subject$] DATE : [@Object$]4/17/95[@Object$] DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR [@Subject$]ADMISSION[@Subject$] : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . AFTER | |
| 383_TL1 DISCHARGE 07/16/95 ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . OVERLAP ADMISSION DATE : 4/17/95 [@Subject$]DISCHARGE[@Subject$] DATE : [@Object$]07/16/95[@Object$] HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . BEFORE | |
| 383_TL10 Vassdiysey Medical Center Vassdiysey Medical Center ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . OVERLAP ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from [@Subject$][@Object$]Vassdiysey Medical Center[@Object$][@Subject$] for rule out pancreatic pseudocyst . OVERLAP | |
| 383_TL100 the pancreatic necrosis Drainage ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . BEFORE [@Object$]Drainage[@Object$] of [@Subject$]the pancreatic necrosis[@Subject$] was also done . AFTER | |
| 383_TL101 the procedure An exploratory laparotomy ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . OVERLAP [@Object$]An exploratory laparotomy[@Object$] was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated [@Subject$]the procedure[@Subject$] fairly well , and was transferred to the Intensive Care Unit . AFTER | |