CHIEF COMPLAINT: [**Known firstname 21258**] [**Known lastname 53988**] was an inpatient under
the care of Dr. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) **] of the General Surgery
Purple Service.  Chief complaint is esophageal perforation.

PRESENT ILLNESS: The patient is a 25-year-old man
with a prior medical history of acolasia who received a
laparoscopic hilar myotomy five days prior to admission.  He
did well postoperatively with some mild complaints of pain
which was well controlled with narcotics until earlier on the
day of admission when he began having sharp severe abdominal
pain radiating to his back and chest bilaterally.

MEDICAL HISTORY: Acolasia.

MEDICATION ON ADMISSION: Roxicet as needed.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He smokes half a pack of cigarettes per day
with occasional alcohol use.
Perforation of esophagus,Other postoperative infection,Laparoscopic surgical procedure converted to open procedure,Anxiety state, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Perforation of esophagus,Other postop infection,Lap surg convert to open,Anxiety state NOS,Abn react-surg proc NEC
Admission Date:  [**2174-1-3**]     Discharge Date:  [**2174-1-12**]

Date of Birth:   [**2148-3-17**]     Sex:  M

Service:

CHIEF COMPLAINT:  [**Known firstname 21258**] [**Known lastname 53988**] was an inpatient under
the care of Dr. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) **] of the General Surgery
Purple Service.  Chief complaint is esophageal perforation.

HISTORY OF PRESENT ILLNESS:  The patient is a 25-year-old man
with a prior medical history of acolasia who received a
laparoscopic hilar myotomy five days prior to admission.  He
did well postoperatively with some mild complaints of pain
which was well controlled with narcotics until earlier on the
day of admission when he began having sharp severe abdominal
pain radiating to his back and chest bilaterally.

He complains of chills and nausea.  He reports only a small
amount of flatus and diarrhea.  He had been tolerating a
normal soft diet until the night prior to admission.  He has
no dysuria.  The pain that he describes is constant, severe,
sharp, and not relieved by anything.

PAST MEDICAL HISTORY:   Acolasia.

PAST SURGICAL HISTORY:  Laparoscopic [**Doctor Last Name **] myotomy on
[**2173-12-29**].

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Roxicet as needed.

SOCIAL HISTORY:  He smokes half a pack of cigarettes per day
with occasional alcohol use.

PHYSICAL EXAMINATION ON PRESENTATION:  His temperature was
94.6, his heart rate was 65, his blood pressure was 135/78,
and his oxygen saturation was 100% on room air.  He was
somewhat lethargic with clammy and cool extremities.  He was
anicteric.  His lungs were clear to auscultation bilaterally
with some subcutaneous emphysema noted in the upper chest and
neck region.  His heart was regular rate and rhythm first
heart sounds and second heart sounds.  His abdomen was soft
and nondistended but was diffusely tender with no guarding.
His incisions were clean, dry, and intact.  His extremities
were well perfused with 2+ dorsalis pedis pulses.

BRIEF SUMMARY OF HOSPITAL COURSE:  The concern for an
esophageal perforation following his esophageal surgery was
immediately noted, and the patient was taken upstairs to
Radiology for an emergent upper gastrointestinal contrast
swallowing study to identify suspected leak. The upper
gastrointestinal swallow study with gastrografin did in
fact,demonstrate a leak in the area of the gastroesophageal
junction. The patient
was taken straight to the operating room.
The patient was made nothing by mouth and given intravenous
fluid resuscitation and intravenous antibiotics.  He had a Foley
catheter
placed and was consented for this procedure.  Please refer to the
dictated Operative Report by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] from
[**2174-1-3**].

In brief, a laparoscopic examination of the previous
operative field was performed and a inflamed stomach with
evidence of a leak from the stomach was apparent.  At that
point, the surgery was converted to an open procedure.
Inspection of the of the operative field once the surgery was
converted to open revealed approximately a 3-mm perforation
which was closed with interrupted vicryl sutures.  In
addition to the sutures, a partial wrap (Dor plication) was
performed of the fundus to help cover the area of esophageal
leak. Finally, a
gastrostomy tube and feeding jejunostomy were placed.  Two
[**Location (un) 1661**]- [**Location (un) 1662**] drains were placed in
the region of the esophageal tear.

The patient tolerated the procedure extremely well and was
transferred to the Postanesthesia Care Unit and to the
Intensive Care Unit without complications.

On postoperative day one, after overnight Intensive Care Unit
monitoring, the patient was transferred to the floor in
relatively good condition.

Despite the severity of the patient's disease, his
postoperative course was relatively unremarkable.  He was fed
with total parenteral nutrition in the first few days
following surgery and eventually with tube feeds via his
jejunostomy tube.  On postoperative days three and four,
respectively, a methylene blue study and an upper
gastrointestinal series revealed showed no evidence of a leak
from the esophagus through the repaired esophageal tear.

On postoperative day five, the patient was started on sips of
clear liquids which he tolerated well.  He was slowly
advanced to full liquids and to a soft solid diet which he
tolerated without nausea, vomiting, or abdominal pain.

The only complication during the patient's postoperative
course was a temperature to 101.8 on postoperative day five.
At that time, his cultures were sent and his central venous
line was changed over a wire.  On postoperative day nine, the
patient was tolerating a soft solid diet.  He had been
afebrile for several days and was without any abdominal pain.

DISCHARGE STATUS:  The patient was discharged to home.

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE DIAGNOSES: (His discharge diagnoses were as
follows)
1.  Esophageal acolasia; status post [**Doctor Last Name **] myotomy.
2.  Esophageal perforation/esophageal leak; status post
repair of esophageal leak on [**1-3**].
3.  Status post gastrostomy tube placement on [**1-3**].
4.  Status post feeding jejunostomy tube placement on
[**1-3**].
5.  Hyperalimentation.
6.  Central venous line placement.
7.  Central venous line exchange.

MEDICATIONS ON DISCHARGE:  (He was sent home with the
following discharge medications)
1.  Prevacid 30 mg by mouth once per day.
2.  Roxicet one to two teaspoons q.4-6h. as needed (for
pain).
3.  Colace 100 mg by mouth twice per day as needed (for
constipation).
4.  Ativan 0.5 mg by mouth four times per day as needed (for
anxiety).

He was taking Replete tube feeds prior to discharge.  If he
is unable to sustain himself, he will take have cycled
Replete tube feeds.  Please refer to the discharge paperwork
for the specific strength and rate of these tube feeds.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 9325**], M.D.  [**MD Number(1) 10637**]

Dictated By:[**Last Name (NamePattern1) 1179**]

MEDQUIST36

D:  [**2174-1-11**]  12:24
T:  [**2174-1-11**]  14:38
JOB#:  [**Job Number 53989**]
{'Perforation of esophagus,Other postoperative infection,Laparoscopic surgical procedure converted to open procedure,Anxiety state, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: [**Known firstname 21258**] [**Known lastname 53988**] was an inpatient under
the care of Dr. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) **] of the General Surgery
Purple Service.  Chief complaint is esophageal perforation.

PRESENT ILLNESS: The patient is a 25-year-old man
with a prior medical history of acolasia who received a
laparoscopic hilar myotomy five days prior to admission.  He
did well postoperatively with some mild complaints of pain
which was well controlled with narcotics until earlier on the
day of admission when he began having sharp severe abdominal
pain radiating to his back and chest bilaterally.

MEDICAL HISTORY: Acolasia.

MEDICATION ON ADMISSION: Roxicet as needed.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He smokes half a pack of cigarettes per day
with occasional alcohol use. 

### Response:
{'Perforation of esophagus,Other postoperative infection,Laparoscopic surgical procedure converted to open procedure,Anxiety state, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
