CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 50-year-old
female with a history of Crohn's colitis who complains of
three days of abdominal pain, mostly in the left lower
quadrant.  Chest x-ray revealed free air.  The patient also
had a white blood cell count of 16.  The patient was admitted
to the hospital.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Perforation of intestine,Regional enteritis of unspecified site,Pneumonia due to escherichia coli [E. coli],Peritoneal adhesions (postoperative) (postinfection),Diverticulosis of colon (without mention of hemorrhage)
Perforation of intestine,Regional enteritis NOS,Pneumonia e coli,Peritoneal adhesions,Dvrtclo colon w/o hmrhg
Admission Date:  [**2151-7-29**]     Discharge Date:  [**2151-8-15**]

Date of Birth:   [**2101-4-25**]     Sex:  F

Service:  General Surgery - Blue Team

HISTORY OF PRESENT ILLNESS:  The patient is a 50-year-old
female with a history of Crohn's colitis who complains of
three days of abdominal pain, mostly in the left lower
quadrant.  Chest x-ray revealed free air.  The patient also
had a white blood cell count of 16.  The patient was admitted
to the hospital.

HOSPITAL COURSE:  Considering the free air, there was a
likely perforated viscus so the patient was immediately taken
to the operating room on [**7-29**].  The patient underwent
exploratory laparotomy, lysis of adhesions, sigmoid colectomy
and colostomy and Hartmann's for a perforated sigmoid colon.
Surgeon of record was Dr. [**Last Name (STitle) **].  Assistant, Dr. [**Last Name (STitle) 9779**].
Findings included multiple intraperitoneal abscesses,
perforated sigmoid colon.

Post-operatively the patient was taken to the ICU with a
Propofol drip for sedation, was intubated especially
considering the patient's history of idiopathic pulmonary
fibrosis.  The patient also required Neo and a Swan as the
case intraoperatively was complicated by hypotension.  The
patient was put on Vancomycin, Levofloxacin and Clindamycin
and Protonix, subcu Heparin and a regular insulin sliding
scale.  Over the next few days the patient was able to be
weaned off of pressors and the SICU team continued to attempt
to wean the patient from the ventilator. On [**7-31**] the patient
was extubated.  Incidentally cultures came back that day from
the intraabdominal fluid, gram positive cocci 3+, gram
negative rods 4+, gram positive rods 3+.  Status post
extubation the patient had several episodes of respiratory
distress, likely the patient's history of pulmonary fibrosis
and pulmonary hypertension contributed to this.  The patient
did receive some Lasix with a good effect as she had received
a large amount of fluid perioperatively.  As of [**8-1**] the
patient required 100% non rebreather with O2 sats greater
than 90%.  The patient remained on Hydrocortisone as
treatment for the patient's pulmonary fibrosis and pulmonary
hypertension and was also receiving Lasix 20 mg [**Hospital1 **].  The
patient continued to get aggressive chest physical therapy.
Cultures on the patient's endotracheal tube grew out E. coli
and Ceftriaxone was added to the Vanco, Levofloxacin,
Clindamycin antibiotic regimen.  The patient's respiratory
status continued to improve and thus the patient was sent to
the floor.  On [**8-5**] the patient was satting 94% on 40% plus 6
liters nasal cannula.  The patient had an episode of
desaturation on 6 liters to 88% on [**8-7**].  More aggressive
pulmonary toilet was required.  The patient was put on 100%
non rebreather and sats came up to 95%.  Levofloxacin was
discontinued.  TPN was started.  The patient was advanced to
clear diet on [**8-9**].  The patient had an episode of
desaturation on the night of [**8-9**], desaturated to 82% on mask,
up to 99% on non rebreather.  Also complained of feeling of
dyspnea.  At 1 a.m. on [**8-10**] the patient complained of chest
pain.  EKG showed no change.  Chest x-ray showed no change
from [**8-7**].  ABG was 7.47/43/64/32/6 on 15 liters non
rebreather.  The patient was given Lasix and then was
transferred back to the SICU.  The patient was found on CT
scan to have a small fluid collection in the pelvis which had
had a pigtail catheter in.  This drainage tube was clogged
[**8-10**], interventional aspirated and flushed the tube and
unclogged it and orders were written to flush his catheter
tid.  Respiratory service was consulted on [**8-11**].  The
pulmonologist recommended continuing antibiotics, tapering
Hydrocortisone, continuing general diuresis.  On [**8-13**] the
patient was requiring C-pap to maintain oxygen saturation and
at noon on [**8-13**] the patient was reintubated.  Patient's blood
pressure dropped to 80/40 so the patient was put on
Neo-Synephrine.  On [**8-14**] the patient underwent a bronchoscopy
that showed thick secretions.  During the procedure the
patient had episodes of hypotension and tachycardia.  The
patient required FIO2 in the 90% range to maintain O2
saturation.  ICU team was unable to wean down the FIO2.
Every time they attempted to wean down the FIO2 the patient
would desaturate.  On [**8-15**] the patient required an FIO2 of
100% to maintain O2 sats in the low 90's.  At this point in
time it appeared that secondary to patient's history of
idiopathic pulmonary fibrosis, the patient's prognosis was
very poor and this poor prognosis was discussed with the
family.  At noon the family decided that in light of the
patient's poor prognosis, she should be made comfort measures
only.  The patient was thus taken off all pressors and was
pronounced dead at 12:50 p.m. on [**8-15**] and the death
certificate was filed.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3799**], M.D.  [**MD Number(1) 3800**]

Dictated By:[**Last Name (NamePattern1) 4039**]

MEDQUIST36

D:  [**2151-9-22**]  11:20
T:  [**2151-9-22**]  13:12
JOB#:  [**Job Number **]
{'Perforation of intestine,Regional enteritis of unspecified site,Pneumonia due to escherichia coli [E. coli],Peritoneal adhesions (postoperative) (postinfection),Diverticulosis of colon (without mention of hemorrhage)'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 50-year-old
female with a history of Crohn's colitis who complains of
three days of abdominal pain, mostly in the left lower
quadrant.  Chest x-ray revealed free air.  The patient also
had a white blood cell count of 16.  The patient was admitted
to the hospital.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Perforation of intestine,Regional enteritis of unspecified site,Pneumonia due to escherichia coli [E. coli],Peritoneal adhesions (postoperative) (postinfection),Diverticulosis of colon (without mention of hemorrhage)'}
