Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Hiatus hernia, Intestinal perforation, Large intestine perforation, Ostomy bag placement, Ovarian cancer
Clinical narrative: Received COVID vaccine on 3/5/21, tested positive for COVID on 8/7/21  8/6/21:Patient is a 72 y.o. female with a history of HTN, COPD, HLD who presents to the Emergency Department for evaluation of bowel perforation.  Patient reports she started having lower abdominal pain approx 1 week ago.  States her pain went away after a few days.  2 days ago her pain returned, and has progressively worsened.  Seen at the hospital today, had CT scan that showed findings concerning for bowel perforation with stool contamination, abscess, and possible malignancy.  Patient denies hx of previous abdominal surgeries.  States her pain is tolerable as long as she remains still.  Denies fever, chills, body aches, chest pain, palpitations, shortness of breath, wheezing, dizziness, lightheaded, syncope, dysuria.     72y female with COPD and no known history of cancer who presents with abdominal pain and CT findings consistent with feculent perforation of the sigmoid colon, sigmoid mass with concern for metastasis, and 2 large pelvic abscesses. Patient is hemodynamically stable, but given that pain is consistent with peritonitis and with the findings of free air within her hiatal hernia, will plan to take patient to OR emergently for lap sigmoid ectomy with end colostomy. Risks, benefits, and alternatives of the procedure were discussed with the patient. Patient elected to proceed to the OR. Code status discussed and patient is full code. Patient will be posted as an A and will be admitted to colorectal surgery following the procedure.    #Perforated sigmoid mass #Intra-pelvic feculent abscesses - To OR as A for laparoscopic sigmoidectomy, end colostomy, and all other indicated - NPO - IVF @ 100 - zosyn 3.375 IV - Dilaudid for pain control - Admit to colorectal surgery following procedure - Consent signed and in chart  8/17/21 Discharge Summary: Hospitalization Admit Date/Time: 8/6/2021  5:05 PM Discharge Date: 08/17/21 No address on file   Chief Concern, Brief History of Present Illness, and Hospital Course Patient is a 72 y.o. female with COPD who presented to ED with abdominal pain, evidence of bowel perforation.  They were evaluated and found to have perforated sigmoid mass and intra-pelvic feculant abscess. They were taken to the operating room on 8/6 for emergent laparoscopic sigmoidectomy and end colostomy. Patient found to have involvement of left ovary and tube as well as small bowel; therefore, left SPO and SBR performed as well.  The patient tolerated the procedure well and was subsequently extubated and transferred to the PACU for recovery. After recovery, the patient was transferred to the floor. Patient's COVID test was positive, so she was transferred to COVID unit. She received aggressive respiratory therapy. With her COPD, she was high risk for severe infection; however, her respiratory status has slowly improved. She is now on 1L O2 nc. Of note, she was vaccinated. The patient's hospital course was otherwise uncomplicated and it was felt that the patient had reached maximal benefit from hospitalization. They were deemed appropriate for discharge to acute rehab. On the day of discharge the patient's pain was controlled on oral medications, they were ambulating, voiding appropriately, passing flatus and stool in ostomy bag, and tolerating oral intake. Patient becoming more comfortable with changing ostomy bag herself, but struggles with dexterity. Has some deconditioning. Of note, her pathology returned as likely ovarian cancer. She will follow up outpatient with Dr. The patient was discharged on 08/12/21 to rehab and will return to clinic in 1 month with Dr.  Discharge Diagnosis Medical Problems     Active and Resolved Hospital Problems        Hospital    Aspiration pneumonitis (CMS/HCC)    Overview Addendum 8/16/2021  7:55 AM by MD       -confirmed by CXR -speech consulted- no dysphagia, okay for regular diet and thin liquids -monitor for signs of pneumonia -no concern for pneumonia       COPD (chronic obstructive pulmonary disease) (CMS/HCC)    Overview Signed 8/14/2021 11:54 AM by MD       Complicates all aspects of care Increases risk for severe COVID infection       Clear cell carcinoma (CMS/HCC)    Overview Signed 8/14/2021 11:55 AM by MD       -thought to be gyn primary       * (Principal) Bowel perforation (CMS/HCC)    Overview Addendum 8/16/2021  7:56 AM by MD       -s/p lap colectomy, end colostomy, SBR, and left salpingo-oophorectomy (8/7) -Path: HIGH-GRADE CARCINOMA WITH CLEAR CELL AND SARCOMATOID DIFFERENTIATION, INVOLVING FALLOPIAN TUBE, OVARY, COLON MUSCLE WALL AND MESENTERY. ONE LYMPH NODE NEGATIVE FOR METASTASIS (0/1). Dr. discussed with Dr., will see outpatient. -IS/OOB, Flutter Valve for IS -Regular diet, HLIV -PT/OT: acute recs, appreciate visits - Pending insurance approval to ARF, medically stable for discharge - SW states she will require transportation to rehab facility due to Covid (+)       COVID-19    Overview Addendum 8/14/2021 11:53 AM by MD    -On 3L O2 at home in past, now on 1L nasal cannula -Duo-nebs PRN for wheezing -formal consult to RT -chest physiotherapy and airway clearance