CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 77-year-old
male with a very complicated past medical history.  He was
seen at an outside hospital where he was found to have a
perforated sigmoid colon.  He underwent a sigmoid resection
with colostomy and Hartmann's on [**2131-11-3**].  Intraoperatively,
[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 406**] drain was placed.

MEDICAL HISTORY: 1. Hypertension.
2. PMR.
3. Spinal stenosis.
4. COPD, on steroids and home O2.
5. Chronic pneumonia.
6. Paroxysmal atrial fibrillation.
7. Impaired glucose tolerance.
8. GERD.
9. Abnormal LFTs, status post stent of common bile duct
stricture and stone removal.
10.Benign colon polyps.

MEDICATION ON ADMISSION: 

ALLERGIES: Sulfa.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for father dying of colon cancer at
age 67.

SOCIAL HISTORY: Denies tobacco or ETOH.
Other postoperative infection,Hernia of other specified sites, with obstruction,Paralytic ileus,Intestinal infection due to Clostridium difficile,Pneumonia, organism unspecified,Atrial fibrillation
Other postop infection,Hernia, site NEC w obstr,Paralytic ileus,Int inf clstrdium dfcile,Pneumonia, organism NOS,Atrial fibrillation
Admission Date:  [**2131-11-6**]       Discharge Date:  [**2131-12-17**]

Date of Birth:   [**2054-6-16**]       Sex:  M

Service:

ADMITTING DIAGNOSIS:
Ileus and question of ischemic ostomy.

DISCHARGE DIAGNOSES:
1. Status post perforated sigmoid with sigmoid resection,
colostomy and Hartmann's, [**2131-11-3**] at an outside hospital
with Hartmann's breakdown.  Transferred to [**Hospital6 1760**] for further evaluation.
2. Small bowel obstruction.
3. Breakdown of Hartmann's with abscess collection, fascial
dehiscence with take back to the operating room for closure
of fascia and pelvic washout, [**2131-11-13**].
4. Clostridium difficile positive on [**12-11**].
5. [**Hospital **] hospital acquired pneumonia, on antibiotics.
6. Prolonged postoperative ileus.
7. Bradycardia of unclear etiology, likely secondary to
vasovagal episode.
8. Malnutrition requiring total parenteral nutrition.

HISTORY OF PRESENT ILLNESS:  The patient is a 77-year-old
male with a very complicated past medical history.  He was
seen at an outside hospital where he was found to have a
perforated sigmoid colon.  He underwent a sigmoid resection
with colostomy and Hartmann's on [**2131-11-3**].  Intraoperatively,
[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 406**] drain was placed.

The postop course was complicated by a rise in INR to 4
requiring 8 of FFP.  He was also noticed to have some
abdominal tenderness and a dusky ostomy, and thus a CT scan
was performed which showed ileus and no fluid collection.
The family requested transfer on postop day #5 to [**Hospital6 1760**] where the patient came for
further care and evaluation.

PAST MEDICAL HISTORY:
1. Hypertension.
2. PMR.
3. Spinal stenosis.
4. COPD, on steroids and home O2.
5. Chronic pneumonia.
6. Paroxysmal atrial fibrillation.
7. Impaired glucose tolerance.
8. GERD.
9. Abnormal LFTs, status post stent of common bile duct
stricture and stone removal.
10.Benign colon polyps.

PAST SURGICAL HISTORY:
1. Appendectomy.
2. Sigmoid resection, colostomy and Hartmann's, [**2131-11-3**].

ALLERGIES:  Sulfa.

MEDS ON TRANSFER:
1. Ativan 0.5 q 4 h prn anxiety.
2. Albuterol MDI 2 q h prn.
3. Tylenol prn.
4. Meropenem.
5. Protonix 40 mg IV qd.
6. Lasix 20 IV q am.
7. Solu-Medrol 40 IV qd.
8. Advair 250/50, 1 inhaler [**Hospital1 **].

MEDS AT HOME:
1. Coumadin 7.5 mg po qd.
2. Prednisone 10 mg po qd.
3. Lasix 20 mg po qd.
4. Potassium chloride 10 mg po qd.
5. Iron 325 qd.
6. Tylenol #3 prn.
7. Aciphex 20 mg po qd.
8. Flovent.
9. Serevent.
10.Albuterol.

SOCIAL HISTORY:  Denies tobacco or ETOH.

FAMILY HISTORY:  Positive for father dying of colon cancer at
age 67.

EXAM ON ADMISSION:  The patient is afebrile.  His vital signs
are normal.  He is anicteric.  His lungs are clear with
decreased breath sounds at the bases.  His heart is regular.
His abdomen is distended, diffusely tender, with some
inferior ecchymosis and erythema around his wound.
Extremities have some painful varicosities and 2+ pitting
edema.  Rectal - the anastomosis is not palpated.  Some gross
positive blood was found.  The ostomy was darkish, was dusky
in color, with flatus in the bag.

HOSPITAL COURSE:  The patient was seen and evaluated on
[**2131-11-7**].  It was thought that he had a postop ileus.  There
was also question of slightly dusky ostomy, although when it
was cannulated with a test tube, the mucosa appeared to be
pink proximal to the area that was in question.

The patient was admitted and underwent a CT scan which showed
a stable collection in his pelvis.  The patient was followed
closely,  and given the fact that several days into his
hospital course his wound began to open, it became clear that
he had a fascial dehiscence.  On [**2131-11-13**], he was taken to
the OR for an exploratory laparotomy, lysis of adhesions, and
repair of his Hartmann's which was seen to have broken down,
as well as a pelvic washout.

The patient did well postoperatively.  He was cared for in
the ICU and then transferred to the floor.  He was placed on
broad-spectrum antibiotics given the collection in his
abdomen.  He did have a prolonged ileus postop, and was
placed on TPN.  Slowly, however, his bowel function returned.
On [**12-11**], he was noted to be C. diff positive and was started
on Flagyl.  His wound was packed with wet-to-dry dressing
changes on a daily basis and slowly improved.  Also of note,
the patient was thought to have an infiltrate on chest x-ray
and was started empirically on Levofloxacin for a 14-day
course.

Given the fact that the patient was thought to be doing well,
afebrile and tolerating a regular diet, on [**2131-12-17**], he was
discharged to rehab in stable condition on the following
medications.

DISCHARGE MEDICATIONS:
1. Albuterol 1-2 puffs q 6 h prn.
2. Ipratropium 1 puff q 6 h.
3. Regular insulin sliding scale.
4. Tamsulosin 0.4 mg capsule qd.
5. Vitamin A.
6. Multivitamin.
7. Protonix 40 mg po qd.
8. Tylenol with percocet 1-2 tabs po q 4-6 h prn.
9. Zinc sulfate.
10.Vitamin C.
11.Prednisone 10 mg po qd.
12.Potassium chloride 10 mg po qd.
13.Dronabinol 2.5 mg po bid.
14.Megestrol acetate 40 mg po qd.
15.Erythromycin ointment to his eye qid.
16.Colace 100 mg [**Hospital1 **].
17.Coumadin 7.5 mg po qd with a daily INR check.
18.Flagyl 500 mg po tid, to end [**12-27**].
19.Nasal spray tid prn.
20.Levofloxacin 500 mg po qd, to end [**12-27**].
21.Milk of Magnesia prn.
22.Cepacol prn.

The patient was discharged to rehab in good condition.

TREATMENT PLAN:
1. Ostomy care with normal saline to clean the defects around
his ostomy at 3 o'clock and 9 o'clock with appliance change.
2. Out-of-bed tid with an abdominal binder.
3. Boost tid with meals.
4. Fingersticks qid.
5. Normal saline wet-to-dry dressing changes to abdomen [**Hospital1 **].
6. INR checks qd.
7. Regular diabetic diet.
8. Physical therapy on a daily basis.
9. He should follow-up with Dr. [**Last Name (STitle) **] in [**5-24**] days.


                DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 02-923



Dictated By:[**Last Name (NamePattern1) 4985**]
MEDQUIST36

D:  [**2131-12-17**]  11:51
T:  [**2131-12-17**]  11:56
JOB#:  [**Job Number 106143**]
{'Other postoperative infection,Hernia of other specified sites, with obstruction,Paralytic ileus,Intestinal infection due to Clostridium difficile,Pneumonia, organism unspecified,Atrial fibrillation'}


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 77-year-old
male with a very complicated past medical history.  He was
seen at an outside hospital where he was found to have a
perforated sigmoid colon.  He underwent a sigmoid resection
with colostomy and Hartmann's on [**2131-11-3**].  Intraoperatively,
[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 406**] drain was placed.

MEDICAL HISTORY: 1. Hypertension.
2. PMR.
3. Spinal stenosis.
4. COPD, on steroids and home O2.
5. Chronic pneumonia.
6. Paroxysmal atrial fibrillation.
7. Impaired glucose tolerance.
8. GERD.
9. Abnormal LFTs, status post stent of common bile duct
stricture and stone removal.
10.Benign colon polyps.

MEDICATION ON ADMISSION: 

ALLERGIES: Sulfa.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for father dying of colon cancer at
age 67.

SOCIAL HISTORY: Denies tobacco or ETOH. 

### Response:
{'Other postoperative infection,Hernia of other specified sites, with obstruction,Paralytic ileus,Intestinal infection due to Clostridium difficile,Pneumonia, organism unspecified,Atrial fibrillation'}
