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Elective Surgery in the Setting of Comorbid Anesthesia Risk

EM is a 46-year-old woman with symptomatic cholelithiasis and multiple medical problems. Eight years prior to the present admission she underwent a total proctocolectomy, ileostomy, and right salpingo-oophorectomy for granulomatous colitis. Since that time she has had many abscesses and draining sinus tracts, necessitating surgery, although she has experienced no further symptoms of gastrointestinal distress. One month ago EM suffered an episode of non-A, non-B viral hepatitis, with her bilirubin level peaking at 11.3 mg/dl and subsequently returning almost to normal. At the present time she has slightly elevated serum levels of aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT), lactate dehydrogenase (LDH), and alkaline phosphatase. At the same time as the diagnosis of hepatitis was made, she was found