history of present illness: this is a 70-year-old, nondiabetic white male, with a history of myocardial infarction, coronary artery bypass grafting, who was recently evaluated for a symptomatic prostate. on physical exam the patient was found to have a pulsatile abdominal mass by his primary care physician. scan of the abdomen done at showed an infrarenal abdominal aortic aneurysm with dimensions of 8.1 x 8.7 cm. the patient denied any history of abdominal pain, back pain or claudication symptoms. the patient was referred to dr. for further treatment and was seen in the office on . cta of his abdomen and pelvis revealed that the patient was not a candidate for endovascular repair of his abdominal aortic aneurysm. dr. saw the patient for preoperative cardiac evaluation on . a stress test done on , showed a moderate, fixed inferior defect, mild fixed septal defect, and a moderate partially reversible distal anterior defect, global hypokinesis, ejection fraction of 42%. past medical history: 1. coronary artery disease; ami in , ami 200; coronary artery bypass grafting in . 2. congestive heart failure. 3. severe emphysema/chronic bronchitis. 4. hypertension. 5. hypercholesterolemia. 6. pernicious anemia. 7. benign prostatic hypertrophy. 8. moderate dementia. past surgical history: 1. coronary artery bypass grafting times three with left leg vein at in . 2. bilateral inguinal hernia repair. 3. revision of the right inguinal hernia with mesh in . 4. transurethral resection of prostate, . family history: noncontributory. social history: the patient lives alone. he has a daughter who is involved in his care. he is a former cigarette smoker. he does not drink alcohol. allergies: penicillin causes hives. medications on admission: 1. aspirin 81 mg p.o. q.d. 2. lipitor 20 mg p.o. q.d. 3. mavik 1 mg p.o. q.d. 4. metoprolol 50 mg p.o. q.d. 5. zantac 150 mg p.o. q.d. 6. iron 325 mg p.o. q.d. 7. serevent. physical examination: vitals signs: pulse 52, respirations 12, blood pressure 138/80. general: alert, cooperative white male in no acute distress. heent: carotids palpable. no bruits. range of motion within normal limits. heart: regular, rate and rhythm. lungs: clear bilaterally. abdomen: protuberant, nontender, palpable pulsatile abdominal mass present. extremities: feet equally warm. there was a well-healed saphenectomy incision on the left leg. pulse: palpable femoral, popliteal and posterior tibialis pulses bilaterally. laboratory data: on admission, , wbc 8.2, hemoglobin 12.8, hematocrit 37.5, platelet count 255,000; pt 12.6, ptt 25.1, inr 1.0; sodium 142, potassium 4.4, chloride 103, co2 29, bun 17, creatinine 0.9, glucose 82; urinalysis negative. electrocardiogram showed normal sinus rhythm at a rate of 64, nonspecific st wave changes present, possible septal infarct, age undetermined. chest x-ray showed no signs of congestive heart failure or infiltrates, status post cabg and possible sternal revision. hospital course: the patient was admitted to the hospital on , following an uneventful abdominal aortic aneurysm resection with an aorto--iliac bypass graft. estimated blood loss was 2 l. the patient received 2 u packed red blood cells intraoperatively. perioperatively the patient was given intravenous vancomycin because of his history of penicillin allergy. at the end of the surgery, the patient had equally warm feet with a palpable right dorsalis pedis and a palpable left posterior tibial pulse. postoperatively the patient could not be immediately extubated due to his severe pulmonary disease. the patient was weaned slowly and finally was extubated on . the patient's hematocrit decreased to 24.9 on . he was transfused with 2 u packed red blood cells. an episode of melena was noted with a t-max of 100.9??????. over the next few days, the patient had several more episodes of melena and fever. he was cultured and was found to have e. coli urinary tract infection. levofloxacin and flagyl were started. gi was consulted for the patient's recurrent melena and subsequent hematocrit drops. a colonoscopy was done on , which showed diverticulosis, diffuse colitis, inflammatory bowel disease versus infection. biopsy of the left colon showed chronic active colitis with ulceration. biopsy of the sigmoid colon showed chronic active colitis. several stool cultures for c-difficile were negative. flagyl for presumed c-diff colitis was stopped. the patient's abdominal staples were removed on . the patient's diet was advanced as tolerated. physical therapy evaluated the patient for full weightbearing ambulation. they recommended a rehabilitation stay. at the time of dictation, the patient's abdominal incision is clean, dry, and intact. his feet are equally warm with palpable dorsalis pedis pulses bilaterally. the patient will follow-up with dr. in the office following discharge from the rehabilitation facility. discharge medications: 1. lopressor 25 mg p.o. t.i.d. 2. protonix 40 mg p.o. b.i.d. 3. serevent 1-2 puffs b.i.d. 4. atrovent 1 puff q.6 hours. 5. albuterol 1-2 puffs q.6 hours p.r.n. 6. miconazole powder 2% 1 application h.s. p.r.n. 7. colace 100 mg p.o. b.i.d. 8. percocet tab p.o. q.4-6 hours p.r.n. 9. tylenol 325-650 mg p.o. q.4-6 hours p.r.n. condition on discharge: satisfactory. disposition: rehabilitation facility. discharge diagnosis: 1. asymptomatic abdominal aortic aneurysm of 8.7 cm. 2. abdominal aortic aneurysm resection with aorto--iliac bypass graft on . secondary diagnosis: 1. blood loss anemia, status post transfusion. 2. escherichia coli urinary tract infection, treated with levofloxacin. 3. chronic active colitis, colonoscopy by the gi service. 4. moderate dementia. 5. coronary artery disease. 6. hypertension. , m.d. dictated by: medquist36 Procedure: Aorta-iliac-femoral bypass Closed [endoscopic] biopsy of large intestine Resection of vessel with replacement, aorta, abdominal Diagnoses: Other and unspecified noninfectious gastroenteritis and colitis Urinary tract infection, site not specified Congestive heart failure, unspecified Iron deficiency anemia secondary to blood loss (chronic) Other persistent mental disorders due to conditions classified elsewhere Other emphysema Abdominal aneurysm without mention of rupture Diverticulosis of colon (without mention of hemorrhage)