Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: history of present illness: mr. is a 62-year-old otherwise healthy male who has a greater than 50 pack year smoking history. he underwent a turbt for hematuria that ultimately revealed a grade muscle invasive bladder carcinoma. he had a preoperative ct scan that showed no evidence of lymphadenopathy. prior medications: none allergies: penicillin past medical history: otherwise negative. past surgical history: he had a circumcision at age 27. social history: retired appliance repair worker, drinks three cups of coffee per day and drinks alcohol socially. he is no longer smoking. admission physical exam: vital signs: blood pressure 150/92, pulse 80 and regular, respiratory rate 16 unlabored. abdomen: soft, nontender, no palpable masses, no costovertebral angle tenderness, no inguinal lymphadenopathy. genitourinary: normal phallus, meatus and testes, no inguinal hernia. rectal: normal tone, 35 gm prostate, no nodularity, no hemorrhoids, guaiac negative. extremities: neurologically moves all four extremities without difficulty, normal gait, otherwise intact grossly, no cyanosis, clubbing or edema. cardiac: regular rate and rhythm, no murmur, no gallop, normal s1, s2. pulmonary: clear to auscultation bilaterally, no evidence of wheeze, crackle, rhonchi. he was seen by dr. and dr. after being referred for his work up for bladder carcinoma. it was ultimately determined that he would undergo an orthotopic diversion and a continent cutaneous diversion with ilial loop. the patient agreed to the procedure. preoperative hematocrit was 38.2. no chest x-ray was done. preoperatively, electrocardiogram showed no st-t wave changes, normal sinus rhythm, normal axis, no history of q-wave. on , he was admitted to and he underwent a radical cystoprostatectomy with dr. and dr. with dr. assisting. this was performed under general endotracheal anesthesia. the patient received 12.5 liters intraoperatively of intravenous fluid. blood loss for the case was 850 cc. he received 1 unit of autologous blood intraoperatively. urine output for this case was 250 cc. he was given kefzol, gentamicin and flagyl preoperatively. he left the operating room with a suprapubic tube, a foley catheter, jp x2, ureteral stents x2 and nasogastric tube, right ij triple lumen central venous line, as well as a right radial a-line. specimens from the operation included the bladder prostate, bilateral pelvic lymph nodes and distal ureteral cuff margins x2. he was intubated and went to the intensive care unit overnight. he remained hemodynamically stable. on postoperative day #1, the patient was weaned to extubation. he was being maintained on intravenous fluids and epidural. his propofol drip for sedation was weaned off steadily. postoperative hematocrit was 29.4. bun and creatinine were 15 and 0.9, otherwise his electrolytes were unremarkable. he was given pulmonary toilet and ultimately easily weaned from extubation. the remainder of the body of this dictation will be by systems. 1. neurologic: postoperatively, the patient was weaned off of his sedation within the first 24 hours after the surgery. he was alert and oriented, following commands. his pain was being controlled. subsequently during his postoperative qrc, he was changed over to a patient controlled analgesic apparatus. 2. cardiovascular: he remained hemodynamically stable during his entire hospitalization. he was on no beta blockers and no electrocardiogram changes were noted postoperatively. 3. pulmonary: the patient was extubated within 24 hours of surgery. he was given an aggressive pulmonary toilet, including prn albuterol and atrovent nebulizer treatments, incentive spirometry, chest physiotherapy and early mobilization. 4. fluids, electrolytes and nutrition and gastrointestinal: the patient had a protracted postoperative ileus. there was some wound erythema and drainage noted by postoperative day #5. ultimately, greenish effluent was noted. ct scan was obtained. it showed no large collection, but there was a small abnormal amount of fluid in the pelvis. oral contrast only passed bowel at this time. general surgical consultation with dr. was obtained. there was a question of an anastomotic leak at the level of the neobladder. if there was a small leak, the patient was recommended to continue his nasogastric tube to suction, bowel rest, intravenous fluids, tpn and to add some somatostatin. this ultimately became the patient's regimen, therefore by the patient had been started on somatostatin 100 mcg subcutaneous q 8. he was npo except for ice chips. his nasogastric tube was to suction. all of his drains that he came out of the operating room with were being maintained. he was getting serial flushes through the suprapubic tube and foley catheter. jp outputs were noted to be high and bilious, particularly in the right jp. the wound itself, erythema and leak ultimately subsided and was not putting out much and he was given bowel rest over the next several days. ultimately, by postoperative day #11, it was likely that this patient did in fact have an enterocutaneous fistula, status post cystoprostatectomy. it was presumed after analysis of the jp fluid with his creatinine values being somewhat elevated that there was an additional leak from the neobladder. there was a question of whether or not there was communication between the neobladder and the bowel, as well as between the neobladder and skin versus the bowel and skin. by postoperative day #13, the patient underwent a ct scan. ct scan at that time did not show any evidence of leak. contrast did get down to the level of the rectum. it was a rather encouraging study radiographically, however once the patient arrived to the floor after receiving gastrografin his wounds at the site where it had previously been draining at the most inferior margin began to drain copious amounts of enteric contents. at this point, it was clear that he had a enterocutaneous fistula that was widely draining. he was continued on tpn. his pain was being controlled with pca. his electrolytes were serially repleted. jp, amylase, lipase, bilirubin and creatinine were ultimately serially checked. over the next several days, the patient's left jp began not to put out anything. this was ultimately removed 72 hours prior to discharge. right jp continued to drain a fair degree of volume. the contents revealed an amylase value of as high as 24,000 with a lipase in the thousands as well. this was done after the patient was actually allowed to start sipping fluids, as his nasogastric tube had been removed prior to discharge. it was felt that the stimulation of his bowel and the pancreas and the secretion distally may be in fact be detected in our assays from the wound and from the jp. regardless, the patient was hemodynamically stable and otherwise afebrile. by postoperative day #21, the patient was without a jp. he still had a suprapubic tube and foley catheter in place. his right jp was also in place. there was no nasogastric tube, no a-line. the central venous line had been previously discontinued and he was utilizing a right basilic double lumen picc for his tpn and intravenous fluid access. he was tolerating a diet and passing gas and had formed bowel movements at this point in his postoperative course and it was felt that due to his complication, the best scenario would be to send him home with tpn, minimal po intake, maximal 500 cc q 24 hours and to bring him back at a later date for definitive fistulectomy and repair. the patient understands that he will require a future operation and given the type of procedure that he had, there was a high degree of risk for complication postoperatively which he ultimately suffered from. by this point, he was stable and sent home with home vna and home tpn. he will follow up with dr. in the office in a couple of weeks, at which time he should probably receive a fistulogram to better understand the anatomy through this fistula. additionally, the patient will continue tpn as stated and at that time of follow up dr. will discuss surgical options in conjunction with general surgery and dr. service. discharge medications: 1. somatostatin 100 mcg subcutaneous q 8 2. mucomyst 20% 5 cc solution diluted, 30 cc normal saline to be flushed through the suprapubic tube and foley catheter for mucous plugging. 3. percocet 5/325 1 to 2 tablets po q 4 to 6 prn the patient will be on a sliding scale insulin regimen to cover his sugar needs, as well. follow up with dr. will occur in approximately two weeks, at which time the fistulogram will be completed. discharge diagnoses: 1. muscle invasive bladder cancer 2. status post radical cystoprostatectomy with ilial neobladder and urethral anastomosis complicated by postoperative enterocutaneous fistula and question enterovesical fistula, vesical being the neobladder in this instance, not his native bladder as that was removed. , m.d. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances radical cystectomy formation of cutaneous uretero-ileostomy radical groin dissection diagnoses: paralytic ileus fistula of intestine, excluding rectum and anus malignant neoplasm of other specified sites of bladder 

Answer: The patient is high likely exposed to