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: allergies: lisinopril / aspirin enteric coated attending: chief complaint: abdominal distention nausea and vomiting major surgical or invasive procedure: : 1. lysis of single strand adhesion with derotation of a volvulus 2. placement of a nasogastric tube : second look laparotomy history of present illness: 79m s/p repair of aaa presents with abdominal distention, nausea and vomiting. past medical history: cad (s/p cabg), htn, ^lipid, mgus, djd, orthostatic syncope, l4-5 disc herniation. social history: +tobacco; +etoh family history: noncontributory physical exam: admission physical exam- 97.5 68 162/72 18 94% comfortable no icterus/jaundice neck supple ctab cv regular abdomen distended, nt, easily reducible (r)inguinal hernia ext palpable dp (b), no edema pertinent results: cta abd w&w/o c & recons 3:43 am findings: abdomen, the evaluation of upper abdomen is somewhat limited due to motion artifact. the oral contrast seen mostly in stomach and duodenum, and duodenum is dilated, measuring 4.3 cm. there is ascites anterior to the liver, overall unchanged since prior study. in this study, no focal liver lesion is seen. gallbladder, spleen, pancreas, adrenal glands and kidneys are unchanged with renal cyst with perinephritic fat stranding. the patient is status post aortic aneurysm repair with surgical clips. there is no evidence of leak or hematoma. there is small amount of soft tissue surrounding the abdominal aorta at the level of surgery at just below the renal arteries, however, the soft tissue has markedly decreased since prior study. there is markedly dilated loops of small bowel, mostly in mid lower pelvis, measuring up to 3.2 cm associated with moderate amount of ascites, new cyst prior study. the distal small bowel is collapsed, and oral contrast has not reached the small bowel. there are two possible transitional point, one in left lower quadrant and the other one in right lower quadrant. the finding is representing small-bowel obstruction, and its also worrisome for closed loop obstruction or ischemia given the presence of ascites. however, sma and its branches opacified. there is no significant lymphadenopathy. the visualized portion of the large bowel is within normal limits. there is no evidence of free air. in the visualized portion of the lung bases, note is made of basilar atelectasis with left pleural effusion. aspiration or aspiration pneumonia in this area cannot be totally excluded. there is marked degeneration of lumbar spine with vacuum phenomena. there is no suspicious lytic or blastic lesion in skeletal structures. impression: 1. markedly dilated loops of small bowel in mid lower pelvis associated with moderate amount of ascites, with collapsed distal small bowel, representing high grade mechanical small-bowel obstruction, worrisome for closed loop. sma and its branches opacified, however, given the presence of ascites, presence of ischemia cannot be excluded. urgent clinical attention is needed. 2. dilated and fluid-filled duodenum as described above. 3. persistent ascites anterior to the liver. 4. status post aaa repair, without evidence of leak. 5. renal cyst. operative note preoperative diagnosis: acute small-bowel obstruction. postoperative diagnosis: acute small-bowel obstruction with volvulus and an internal hernia. procedures: 1. lysis of single strand adhesion with derotation of a volvulus. 2. placement of a nasogastric tube. assistant: , res and , md. anesthesia: general. surgical findings: this elderly male, status post aortic aneurysmectomy some months ago, presented with a 2 day history of vomiting. he denied abdominal pain and had no acute abdominal findings, however, his white blood cell count was elevated to 11,000. he was brought to surgery. unfortunately, without an ng tube, as we were totally unable to pass it through his nares, it was elected to go ahead and protect his airway, intubate him, and then have ent assist with placement if we could not do it with him asleep. he was, therefore, brought to surgery, anesthetized and an og was put into place and approximately 2 liters of feculent material were recovered from the stomach. the airway was protected throughout the entire time. having accomplished this he had usual prep and draping and had a midline incision. the bowel was very compromised, appeared to be necrotic through approximately 60% of the bowel. he additionally had some some telangiectasias noted on the mesenteric surface and the jejunum and the lao areas. he had a single banjo string adhesion across the base of the mesentery creating an internal hernia through which he had volvulized a significant component of his bowel. after this was taken down with electrocautery to control bleeding the bowel was derotated. the patient did not manifest any unusual acid reperfusion syndrome at that point, however, the bowel over the next ensuing 20 minutes did pink up significantly but still had a significant hemorrhagic aspect to it. there was also a lot of hemorrhage into the mesentery. based on this it was decided that we should do a second look laparotomy the following day for bowel viability. since the bowel looked so much better we did not want to resect a large component that was effected. prior to completion of the procedure the patient had the og removed and we still could not place an ng tube with the patient anesthetized so the ent service came to the room, visualized the nares with a scope and placed mucosal vasoconstrictors and ultimately was able to thread an ng tube through the nose. during the course of the operation we had given considerations to doing a gastrostomy, however, prior to the operation i had been advised by the patient's cardiologist that he was quite noncompliant and that could be a problem in the postoperative management. therefore, in an effort to avoid someone pulling out a tube we decided not to place it if we could get the ng tube. operation: under adequate general endotracheal anesthesia the patient was prepped and draped in the usual fashion. the midline incision was opened and the above noted findings were observed. he had significant adhesions of the omentum to the anterior abdominal wall which were taken down but once we entered the post omental aspect he was fairly free of adhesions. the necrotic bowel and feculent smell immediately met us. we were able to identify the banjo string adhesion very promptly and lyse that, first with electrocautery to control any bleeding and then sharply with the metzenbaum scissors to actually divide the strand. once this occurred we were able to derotate the bowel and as noted above it, over the ensuing several minutes, pinked up fairly well. the bowel was run along its entire course on 2 different runs to make sure there was no perforation and to assess for viability. the remainder of the abdomen was explored and there was found to be no issues. the retroperitoneum was intact without hemorrhage in or around the aortic graft and there appeared to be problem associated with that. after a significant amount of time in the operating room we re-visualized the bowel and the bowel actually had gotten much better in appearance but was still quite dusky looking. because of my lack of confidence that this was going to be recovered bowel we decided to not leave him on the table longer but to just simply bring him back to surgery the next day for a 2nd look. based on this and having an, otherwise, negative exploration of his abdomen the patient had closure with running #1 double looped pds. the skin was closed with skin staples. sterile dressing was applied and the patient was reversed from anesthesia and returned to the icu for further ongoing resuscitation. ent service had been able to successfully place the ng tube and it was elected not to place a gastrostomy tube unless it was necessary on re-evaluation the next day. sponge, needle and instrument count were correct x2. please note this is a re-dictation of an op note which was apparently not able to be found. operative note- preoperative diagnoses: small bowel ischemia. postoperative diagnoses: bowel in recovery. operation: second look laparotomy. assistant: , res , m.d. anesthesia: general findings: this 79-year-old male presenting acutely with a small bowel obstruction 24 hours ago had exploratory laparotomy. he had a single band adhesion around the base of the mesentery with a large component of the small bowel, approximately 60%, quite compromised with venous congestion and ischemia. he was derotated and his mesenteric obstruction was relieved, however, in an effort to preserve bowel he was closed, resuscitated overnight and brought back to surgery today for a second look laparotomy. at surgery today he had recovering bowel identified. there were no areas of frank necrosis. there were areas of obvious suspected mucosal sloughing and there was blood in the right colon which would be consistent with a mucosal slough. the mesenteric hematomas and congestion had cleared out almost entirely and a subserosal lesion which was questioned on the first operation had totally disappeared. therefore, it represented a lymphangiectasia which was dilated secondary to mesenteric compromise. the patient had an abdominal wash out. all of the entire abdomen was inspected. the ng tube was confirmed to be a good location and we reclosed. procedure: under adequate general anesthesia, the patient was prepped and draped in the usual fashion. the midline incision was reopened and the abdomen was explored. there was a fair amount of blood and even feculent smelling exudate in the abdomen. this was all washed out with gentle warm lavage. having accomplished that, the bowel was run in its entirety including the colon. the stomach and the duodenum were noted to be normal in appearance. the ng tube was in good position. the small bowel was run from the ligament of treitz to the ileocecal valve twice to make sure there were no areas of necrosis or pinpoint perforation, primarily because of the odor that was present in the abdomen. after we had totally irrigated the resident fluid out of the abdomen, it was much better and there was no unusual odor. there was no demonstrable fecal leaks and there was no demonstrable small- bowel necrosis. based on this, the patient had a second lavage. the omentum was pulled down over the small bowel and closure was effected using double looped pds to the fascial layers. the skin was closed with staples. sterile dressing was reapplied. the patient was partially reversed from anesthesia but kept on the ventilator and returned the icu for ongoing resuscitation. during the course of the operation, because of his blood loss overnight, he was given 1 unit of blood and 350 cc of crystalloid. brief hospital course: was evaluated in the emergency department at on . initial wbc count was 9.2. kub showed dilated loops of small bowel with air-fluid level, worrisome for small bowel obstruction. he was made npo and iv fluids were started. an ngt was attempted several times without success. he was admitted to the surgery department under the care of dr. . there was reattempt at ngt placement without success. repeat wbc count was 12.6. urinalysis was negative for infection. cta of the abdomen/pelvis was completed which showed markedly dilated loops of small bowel in mid lower pelvis associated with moderate amount of ascites, with collapsed distal small bowel, representing high grade mechanical small-bowel obstruction, worrisome for closed loop. there was no evidence of aaa leak. given these findings he was taken to the operating room where he underwent lysis of a single strand adhesion with derotation of a volvulus; and placement of a nasogastric tube. he tolerated the procedure well and was taken to the icu. at pod 1 he was taken back to the opertating room, as planned, in order to reevaluate the condition of the bowel after resuscitation overnight. recovering bowel was identified with no areas of necrosis. the small bowel was run from the ligament of treitz to the ileocecal valve twice to make sure there were no areas of necrosis or pinpoint perforation and his abdomen copiously irrigated. he tolerated the procedure well and was returned to the icu for continued care. at pod 1 he was extubated. wbc count was 6.9; hct was 28.5. urine output was adequate. ciprofloxacin/flagyl/ampicillin were continued for empiric coverage. at pod he was transferred to the floor. the ng tube had been accidentally removed. he remained npo. at pod he was afebrile and doing well. he was +flatus and his diet was advanced to clears. the urinary catheter was removed. at pod he was tolerating clear liquids. his wbc count was 6.1. he was oob and ambulating. on he was discharged home in good condition. he was to follow up with dr. in clinic in weeks. medications on admission: atenolol asa lovastatin relafen senna discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 2. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation: please hold for loose stools. . disp:*60 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: acute small-bowel obstruction with volvulus and an internal hernia discharge condition: good discharge instructions: please return or contact for: * fever (>101 f) or chills * abdominal pain * nausea or vomiting * inability to pass gas or stool * redness, drainage or bleeding from incision site * chest pain * shortness of breath * any other concerns you may shower; gently wash incision and pat dry. no tub baths or swimming for two weeks. the staples will be removed at your next clinic visit. please resume your home medications as prescribed. please do not drive while taking pain medications. followup instructions: please follow up with dr. in clinic in weeks. please call for an appointment. the number is . you may also call this number for any questions or concerns. procedure: other lysis of peritoneal adhesions reopening of recent laparotomy site intra-abdominal manipulation of small intestine diagnoses: unspecified essential hypertension aortocoronary bypass status other and unspecified hyperlipidemia acute vascular insufficiency of intestine volvulus intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) 

Answer: The patient is high likely exposed to